Focal Ventricular Tachycardias in Structural Heart Disease

Anderson, R. D.; Lee, Geoffrey; Trivic, Ivana; Campbell, Timothy; Pham, Timmy; Nalliah, C.; Kizana, Eddy; Thomas, Stuart P.; Trivedi, S.; Watts, Troy; Kalman, Jonathan M.; Kumar, Saurabh

doi:10.1016/j.jacep.2019.09.013

Cited by 22 publications

(13 citation statements)

References 35 publications

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“…Our approach to EAM and ablation strategy has previously been described 9–11 . EAM and ablation were performed under either conscious sedation or general anaesthesia.…”

Section: Methodsmentioning

confidence: 99%

“…PES was performed from the RV apex, pacing from a 400 ms (ms) drive train and up to 4 extrastimuli, beginning at 300 ms and decrementing by 10 ms down to ventricular refractoriness, as described previously. 9,10 The endpoint for PES was induction of sustained VT for ≥10 s. Left ventricular (LV) stimulation was attempted if monomorphic VT was not induced after right ventricular (RV) stimulation. PES was followed by burst RV pacing from 400 ms in 10-15 beat drive train decrementing by 20 ms down to refractoriness.…”

Section: Programmed Electrical Stimulation (Pes) Protocolmentioning

confidence: 99%

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Correlation of spatial patterns of endocardial pace mapping to underlying scar topography in patients with scar‐related ventricular tachycardia

Kotake

Bennett

Silva

et al. 2023

Cardiovasc electrophysiol

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Introduction: Endocardial pace mapping (PM) can identify conducting channels for ventricular tachycardia (VT) circuits in patients with structural heart disease (SHD). Recent findings show the temporal and spatial pattern of PM may aid identification of the surface harboring VT isthmii. The specific correlation of PM patterns to scar topography has not been examined. Objective: To correlate the pattern of endocardial PMs to underlying scar topography in SHD patients with VT. Methods: Data from patients undergoing VT ablation from August 2018 to February 2022 were reviewed. Results: Sixty-three patients with SHD-related VT (mean age 65 ± 14 years) with 83 endocardial PM correlation maps were analysed. Two main correlation patterns were identified, an "abrupt-change correlation pattern (AC-pattern)" and "centrifugalattenuation correlation pattern (CA-pattern)." AC-pattern had lower scar ratio (unipolar/bipolar % scar area; 1.1 vs. 1.5, p < .001), had longer maximal stimulus-QRS intervals (97.5 vs. 68 ms, p = .002), and higher likelihood of endocardial dominant scar (11/21 [52%] vs. 3/38 [8%], p < .001) than CA-pattern seen on intracardiac echocardiography (ICE). In contrast, CA-pattern was more likely to have epicardial dominant scar or mid-intramural scar on ICE (epicardial dominant scar; CA-pattern: 12/38 [32%] vs. AC-pattern: 1/21 [5%], p = .02, mid-intramural scar; CA-pattern: 15/ 38 [39%] vs. AC-pattern: 1/21 [5%], p = .005).

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“…Our approach to EAM and ablation strategy has previously been described 9–11 . EAM and ablation were performed under either conscious sedation or general anaesthesia.…”

Section: Methodsmentioning

confidence: 99%

Section: Programmed Electrical Stimulation (Pes) Protocolmentioning

confidence: 99%

Correlation of spatial patterns of endocardial pace mapping to underlying scar topography in patients with scar‐related ventricular tachycardia

Kotake

Bennett

Silva

et al. 2023

Cardiovasc electrophysiol

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“…Our approach to mapping and ablation of scar-related ventricular tachycardia (VT) has been described previously. 9) 10) Procedures were performed under either conscious sedation or general anaesthesia. An SL3 sheath (Abbott Medical, Abbott Park, IL, USA) was used to perform coronary sinus venography and a decapolar catheter inserted into the coronary sinus.…”

Section: Methodsmentioning

confidence: 99%

“…If the VT was not tolerated or short in duration, a substrate-based ablation was performed for scar-related VTs. 10) The specific approach targeted presumptive channels and exits as determined by paced QRS morphology matched against the VT QRS morphology with a stimulus-to-QRS interval >40 ms, abnormal fractionated potentials, double potentials, late potentials during sinus and paced rhythm, and local abnormal ventricular activities. 14) …”

Section: Methodsmentioning

confidence: 99%

Ventricular Arrhythmia Burden as a Marker of Success Following Catheter Ablation of Ventricular Arrhythmias in Patients with Structural Heart Disease

et al. 2021

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Background and Objectives There is little emphasis on the efficacy of catheter ablation for ventricular arrhythmia (VA) when using VA burden reduction as a marker for success. We examined the efficacy of catheter ablation using VA burden, rather than VA recurrence as a marker of success, following catheter ablation of structural heart disease (SHD) related VA. Methods Catheter ablation of SHD related VA was performed at a single centre over 4-years. VA episodes and implantable cardioverter defibrillator (ICD) therapies were recorded over the 6-months before and after final ablation. Outcomes were reported in terms of burden reduction and compared to singular VA recurrence. Results Overall, 108 patients were included in the study. Mean age 64.2±13.9 years, 86% male, mean left ventricular ejection fraction (LVEF) 42±16%. Median VA episodes and ICD therapy were significantly reduced after ablation (VA before: 10 [interquartile range, IQR: 2–38] vs. VA after: 0 [IQR: 0–2], p<0.001; anti–tachycardia pacing [ATP] before: 16 (IQR: 1.5–57) vs. ATP after: 0 [IQR: 0–2], p<0.001; shocks before: 1 [IQR: 0–5] vs. shocks after: 0 [IQR: 0–0], p<0.001). Procedural success at 6-months was significantly higher when considering ≥75% reduction in VA burden, rather than a singular VA-free survival (83% vs. 67%, p=0.001). Conclusions The vast majority (>80%) of patients achieve reduction in VA burden (≥75% reduction) after catheter ablation for VA. This data suggests that catheter ablation is highly therapeutic when procedure success is defined as reduction in VA, rather than using a single VA recurrence as a metric for failure.

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“…In the earlier phases of my career, I assumed that epicardial ablation had to be performed under general anesthesia and the pericardial puncture with a breath hold. Subsequently, after experiencing my fair share of non-inducibility and hemodynamically unstable VTs under general anesthesia, and with emergence of data that many patients with presumed scar-mediated VT have focal/triggered VTs [1] that may be easier to induce/map/ablate under moderate/ deep sedation [2], and less inducible and hemodynamically stable under general anesthesia [3], my current practice has shifted to performing epicardial procedures under deep sedation when able. In this issue, Conti et al report their single-center experience of 69 patients undergoing epicardial mapping/ablation under conscious sedation with dexmetomidine [4].…”

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confidence: 99%

Advanced ventricular arrhythmia ablation: step-by-step problem-solving

Nazer

2023

J Interv Card Electrophysiol

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Focal Ventricular Tachycardias in Structural Heart Disease

Cited by 22 publications

References 35 publications

Correlation of spatial patterns of endocardial pace mapping to underlying scar topography in patients with scar‐related ventricular tachycardia

Correlation of spatial patterns of endocardial pace mapping to underlying scar topography in patients with scar‐related ventricular tachycardia

Ventricular Arrhythmia Burden as a Marker of Success Following Catheter Ablation of Ventricular Arrhythmias in Patients with Structural Heart Disease

Advanced ventricular arrhythmia ablation: step-by-step problem-solving

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