Ablation of Ventricular Tachycardia in Chronic Chagasic Cardiomyopathy With Giant Basal Aneurysm

Valdigem, Bruno Pereira; Pereira, Fabio B.F.C.G.; Silva, Nilton J. Carneiro da; Dietrich, Cristiano de Oliveira; Sobral, Ricardo; Nogueira, Fernando Lopes; Berber, Roberto C.; Mallman, Fabricio; Pinto, Ibraim Masciarelli Francisco; Szarf, Gilberto; Cirenza, Cláudio; Paola, Ângelo Amato Vincenzo de

doi:10.1161/circep.110.957571

Cited by 9 publications

(12 citation statements)

References 3 publications

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“…2,57 If endocardial catheter ablation is unsuccessful, or activation mapping during ventricular tachycardia and/ or pace mapping show better activation times and/or pace-map scores in the cardiac veins than at any endocardial site, epicardial catheter ablation using either a transvenous or an intrapericardial approach should be considered ( Figure 3). [9][10][11]28,29,43,44 Intrapericardial access is obtained through a subxiphoidal pericardial puncture, with an epidural introducer needle advanced into the pericardial space under fluoroscopic guidance. 28 Contrast medium is injected to demonstrate the position of the needle tip, and a soft-tipped, floppy guidewire is then introduced (through the needle) until its tip is free within the pericardial space.…”

Section: Catheter Ablationmentioning

confidence: 99%

“…[3][4][5][6] In the past decade, advances in procedural techniques, and improved understanding of electrophysiological mecha nisms, have allowed catheter ablation to be applied to an increasing number of different types of ventricular tachycardia. [7][8][9][10][11][12][13][14][15][16][17] The efficacy and safety of this technique depend on the type and origin of the tachy cardia, 1 which could result from either focal or macro re-entrant mechanisms, and be associated with different substrates, such as an abnormal myo cardium with scarring caused by prior infarction, 11,[17][18][19][20][21] nonischemic cardio myopathy, 12,[22][23][24] prior cardiac surgery, 25 fibrofatty tissue associated with arrhythmogenic right ventri cular dysplasia, 13,26 sarcoidosis, 27 Chagas disease, 28,29 or abnormal cells in the Purkinje network. 14 The optimal strategy for ablation of ventricular tachycardia depends on both the underlying cardiac disease and the electro physiological mechanism of the arrhythmia; therefore, strategies often differ between patients.…”

Section: Introductionmentioning

confidence: 99%

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Optimal ablation strategies for different types of ventricular tachycardias

Yamada

Kay

2012

Nat Rev Cardiol

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Ablation strategies for almost all types of ventricular tachycardias have now been established. The optimal ablation strategy for ventricular tachycardia is determined by the site of origin and the electrophysiological mechanisms. Electrocardiograms, an understanding of the common sites of basic disease, and identification of the scar site using imaging modalities might be helpful for predicting the originating location. Electrophysiological activation mapping is the gold standard for identification of the ventricular tachycardia substrate. However, when activation mapping of scar-related ventricular tachycardias is not possible, substrate mapping might be performed to identify isolated diastolic potentials. Substrates are commonly located in the endocardium, but transvenous or subxiphoidal intrapericardial approaches can be used to map epicardial substrates. Unusual types of ventricular tachycardia might require special strategies, such as transcoronary ethanol or intramural needle ablation. For idiopathic ventricular tachycardias, ablation might be a first-line therapy because of its high efficacy and very low risk of complications. However, the recurrence rate of scar-related ventricular tachycardias remains considerable, and ablation remains an adjunctive therapy to medical therapy and implantable cardioverter-defibrillators. When incessant ventricular tachycardia or fibrillation requiring defibrillator therapy (electrical storm) is refractory to antiarrhythmic drugs, neuraxial modulation, including sedation, might be the next option before catheter ablation is attempted.

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Section: Catheter Ablationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Optimal ablation strategies for different types of ventricular tachycardias

Yamada

Kay

2012

Nat Rev Cardiol

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“…63,64 Valdigem and coworkers show a case of endocardial and epicardial mapping for VT due to Chagas disease, with preprocedure imaging that further illustrates the anatomic relations. 60 Epicardial mapping and ablation procedure are likely associated with a greater risk of complications than endocardial ablation. 65 In a case series Koruth and coworkers describe potential complications related to obtaining epicardial access, mapping and ablation, including pericardial bleeding, subdiaphragmatic bleeding, right ventricular to abdominal fistula, and coronary spasm.…”

Section: Ventricular Arrhythmiasmentioning

confidence: 99%

Fundamental Concepts in Electrophysiology in Cases and Reviews

Stevenson

Asirvatham²

2013

Circ: Arrhythmia and Electrophysiology

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A ssimilating the increasing body of knowledge required for the treatment of patients with cardiac arrhythmias is a substantial task. The trainee is bombarded with chapters and reviews that are important for providing the frame work from which to develop a detailed and nuanced knowledge acquired from clinical experience and ongoing education. Images and Case Reports provide succinct observations of not only a novel or unusual finding, but often of the fundamentals that must be appreciated to place novel findings in context. The Teaching Points series in Circulation Arrhythmia and Electrophysiology provides a more indepth synthesis of case-based learning building on common and uncommon clinical findings. The purpose of this Casebased Curriculum in Clinical Electrophysiology is to provide the clinician and trainee with an easily accessible body of current reviews, cases and Teaching Points that cover a broad range of the field. Links to the individual articles are provided to facilitate using this article as a spring board for review. Fundamentals of Electrophysiology, Mapping, Ablation, and ElectrocardiographyEmergence of complex behavior: An interactive model of cardiac excitation provides a powerful tool for understanding electric propagation. Spector PS, et al. 1 To facilitate an understanding of the relations between electrophysiologic properties and geometry that govern conduction, block and reentry, Spector and colleagues have developed an interactive model that allows the student to study the effects of varying parameters on conduction, block, reentry and even entrainment (http://circep.ahajournals.org/cgi/content/full/CIRCEP.110.961524/DC1). Munoz F, et al. 4 Teaching points with 3-dimensional mapping of cardiac arrhythmia: Mechanism of arrhythmia and accounting for the cycle length. Del Carpio Munoz F, et al. 5 Accurate activation sequence mapping of cardiac arrhythmias is a fundamental skill in cardiac electrophysiology. For complex arrhythmias an electroanatomic mapping system, which allows the mapping data to be displayed on a representation of the anatomy is often employed, as discussed in a series of articles Del Carpio Munoz and colleagues. [3][4][5][6] Accurate mapping requires selecting an appropriate reference point and mapping window and identification of the electrogram that indicates local activation. In applying a mapping strategy it is important to recognize features of macroreentrant, as compared to focal arrhythmias, and to recognize that seemingly small errors in assigning activation times, reference electrograms, or mapping windows, can render a map uninterpretable or meaningless. These issues are discussed in detail. Munoz F, et al. 6 Endocardial unipolar voltage mapping to detect epicardial ventricular tachycardia substrate in patients with nonischemic left ventricular cardiomyopathy. Hutchinson MD, et al. 7 Substrate mapping is a term that refers to localization of the likely arrhythmia substrate, during sinus or paced rhythm rather than during VT, and is of...

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“…Integration of a computed tomography image is particularly useful, because it shows the course of the coronary artery, the size of the ventricular chamber and strategic landmarks. Visualization of the coronary vessels is necessary when an epicardial approach is performed and helps avoid ablation close to a coronary artery branch, which may result in acute myocardial ischemia [62][63][64] . In patients with peculiar anatomy, such as patients with multiple prior surgical intervention for correction of a congenital heart disease or with large aneurysms [64] , a preacquired computed tomography image integrated into the electroanatomic map helps orient mapping.…”

Section: Imaging Integrationmentioning

confidence: 99%

“…Visualization of the coronary vessels is necessary when an epicardial approach is performed and helps avoid ablation close to a coronary artery branch, which may result in acute myocardial ischemia [62][63][64] . In patients with peculiar anatomy, such as patients with multiple prior surgical intervention for correction of a congenital heart disease or with large aneurysms [64] , a preacquired computed tomography image integrated into the electroanatomic map helps orient mapping. Figure 3 shows imaging integration of a computed tomography scan of the right ventricle in a case of post-Fallot VT. During substrate mapping in sinus rhythm, the computed tomography image guided reconstruction of the right ventricular outflow tract and allowed correct identification of the plane of the pulmonary valve, an essential landmark in the approach of this type of VT.…”

Section: Imaging Integrationmentioning

confidence: 99%

Role of catheter ablation of ventricular tachycardia associated with structural heart disease

Ponti

2011

WJC

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In patients with structural heart disease, ventricular tachycardia (VT) worsens the clinical condition and may severely affect the short-and long-term prognosis. Several therapeutic options can be considered for the management of this arrhythmia. Among others, catheter ablation, a closed-chest therapy, can prevent arrhythmia recurrences by abolishing the arrhythmogenic substrate. Over the last two decades, different techniques have been developed for an effective approach to both tolerated and untolerated VTs. The clinical outcome of patients undergoing ablation has been evaluated in multiple studies. This editorial gives an overview of the role, methodology, clinical outcome and innovative approaches in catheter ablation of VT. De Ponti R. Role of catheter ablation of ventricular tachycardia associated with structural heart disease.

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Ablation of Ventricular Tachycardia in Chronic Chagasic Cardiomyopathy With Giant Basal Aneurysm

Cited by 9 publications

References 3 publications

Optimal ablation strategies for different types of ventricular tachycardias

Optimal ablation strategies for different types of ventricular tachycardias

Fundamental Concepts in Electrophysiology in Cases and Reviews

Role of catheter ablation of ventricular tachycardia associated with structural heart disease

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