EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias

Aliot, Étienne; Stevenson, William G.; Almendral-Garrote, Jesus Ma; Bogun, Frank; Calkins, C. Hugh; Delacrétaz, Etienne; Bella, Paolo Della; Hindricks, Gerhard; Jaı̈s, Pierre; Josephson, Mark E.; Kautzner, Josef; Kay, G. Neal; Kuck, Karl Heinz; Lerman, Bruce B.; Marchlinski, Francis E.; Reddy, Vivek Y.; Schalij, Martin J.; Schilling, Richard J.; Soejima, Kyoko; Wilber, David J.

doi:10.1016/j.hrthm.2009.04.030

Cited by 613 publications

(278 citation statements)

References 447 publications

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“…These patients have typically been considered “low risk” for embolic events and guidelines currently do not recommend anticoagulation 20. Similarly, whereas OAC is recommended after VT ablation in patients with structural heart disease, current expert consensus is to not routinely anticoagulate those with a structurally normal heart 21. Data on the presence of structural heart disease in VT ablation patients were not available in this study.…”

Section: Discussionmentioning

confidence: 99%

Ischemic Stroke or Systemic Embolism After Transseptal Ablation of Arrhythmias in Patients With Cardiac Implantable Electronic Devices

Madhavan

Yao

Sangaralingham

et al. 2016

JAHA

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BackgroundIncidental mobile thrombi are commonly found on endovascular leads of cardiac implantable electronic devices (CIEDs). Transseptal puncture for catheter ablation of arrhythmia poses a risk for paradoxical embolism. We examined risk of ischemic stroke, transient ischemic attack (TIA), or systemic embolism after transseptal ablation in patients with and without CIEDs.Methods and ResultsUsing a national administrative claims database, 31 720 patients who underwent a transseptal catheter ablation between January 2004 and September 2014 were identified. Two propensity‐matched cohorts were created by matching demographic variables, administrative variables, Charlson Comorbidity Index, CHA 2 DS 2‐Vasc score, and year and indication for ablation (5533 and 11 300 patients with and without CIEDs). Incidence rates and Cox proportional hazards models were used to estimate risk of ischemic stroke, TIA, or systemic embolism for patients with and without CIEDs. Impact of oral anticoagulation (OAC) use on the endpoint was examined. Over a mean follow‐up of 2.1 years, the incidence of the combined endpoint was 1.9 per 100 person‐years in patients with CIEDs and 1.5 per 100 person‐years in patients without CIEDs (P=0.03). Among patients not on OAC, presence of a cardiac device was associated with an increased risk (hazard ratio [HR], 1.71 [1.24–2.35]; P<0.01), whereas there was no association noted among patients treated with OAC (HR, 0.98 [0.75–1.28]).Conclusion CIEDs are associated with an increased risk of stroke, TIA, or systemic embolism after transseptal ablation, but this risk is attenuated with postablation OAC use. Role of anticoagulation post‐transseptal ablation in patients with CIED warrants further investigation.

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Section: Discussionmentioning

confidence: 99%

Ischemic Stroke or Systemic Embolism After Transseptal Ablation of Arrhythmias in Patients With Cardiac Implantable Electronic Devices

Madhavan

Yao

Sangaralingham

et al. 2016

JAHA

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“…Injury to the coronary arteries from inadvertent radiofrequency application is well described, and specific recommendations for the minimum distance (Ͼ5 mm) between ablation catheter tip and coronary artery have been suggested. 13,14 The sharp edges of intrapericardial sheaths can be traumatic (as was thought to be in the case of patient 6), and therefore soft-tipped sheaths are preferred. Ensuring that the sheath lumen is always occupied by an ablation catheter or pig-tail catheter can also help prevent inadvertent injury from the sheath tip.…”

Section: Complications Related To Epicardial Mapping and Ablationmentioning

confidence: 99%

Unusual Complications of Percutaneous Epicardial Access and Epicardial Mapping and Ablation of Cardiac Arrhythmias

Koruth

Aryana

Dukkipati

et al. 2011

Circ: Arrhythmia and Electrophysiology

104

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Background-Percutaneous epicardial access and mapping/ablation of cardiac arrhythmias are being increasingly performed. Although complications such as pericardial effusion are relatively common, other unusual complications may occur due to the complex anatomic architecture of the heart and surrounding tissues. In this report, we report a series of rare and unusual complications related to percutaneous epicardial procedures. Methods and Results-Between 2006 and 2011, 334 patients underwent attempts at percutaneous, subxiphoid access for epicardial mapping/ablation at 5 experienced centers. Seven selected complications are highlighted in this case series. Patient 1 had a 1-cm right ventricular pseudoaneurysm after several unsuccessful attempts at epicardial access. This was successfully managed conservatively. Patient 2 had intra-abdominal bleeding related to puncture of the left lobe of the liver during access that required surgical repair. Patient 3 had a subcapsular hepatic hematoma that was probably related to percutaneous access and was successfully managed conservatively. Patient 4 had severe pericardial bleeding followed by ventricular fibrillation, immediately after obtaining percutaneous epicardial access. A lacerated middle cardiac vein was repaired surgically. However, the patient ultimately died of complications. Patient 5 had a history of cardiothoracic surgery and developed a right ventricle-abdominal fistula after multiple attempts at percutaneous access. This was surgically repaired without major sequelae. Patient 6 had cardiac tamponade caused by a lacerated coronary sinus branch during epicardial catheter ablation and required surgical repair. Patient 7 had severe left coronary vasospasm and ventricular fibrillation during catheter manipulation in the pericardium. This complication was successfully managed with intracoronary nitrates. Conclusions-Though generally safe, percutaneous epicardial access and mapping/ablation can result in uncommon complications. Awareness of these rare complications may facilitate early detection and successful management. (Circ Arrhythm Electrophysiol. 2011;4:882-888.)

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“…2 Catheter ablation, in cases of recurrent VT and monomorphic focal PVCs, is the method of choice for the management of arrhythmia. 3 The ablation success rate of VT and PVC is between 60 to 90%, with low complication rates. The indication of ablation therapy is based on the patient's symptoms and life quality influences, surface ECG, Holter-monitoring and the location of PVCs.…”

Section: Introductionmentioning

confidence: 99%

Acute Cardiac Tamponade after Left Sided Premature Ventricular Contraction Ablation

Kis

Tamás

István

2016

Journal of Cardiovascular Emergencies

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EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias

Cited by 613 publications

References 447 publications

Ischemic Stroke or Systemic Embolism After Transseptal Ablation of Arrhythmias in Patients With Cardiac Implantable Electronic Devices

Ischemic Stroke or Systemic Embolism After Transseptal Ablation of Arrhythmias in Patients With Cardiac Implantable Electronic Devices

Unusual Complications of Percutaneous Epicardial Access and Epicardial Mapping and Ablation of Cardiac Arrhythmias

Acute Cardiac Tamponade after Left Sided Premature Ventricular Contraction Ablation

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