Guidance for catheter ablation of ventricular arrhythmia

Potse, Mark; Essebag, Vidal

doi:10.1007/s11517-008-0428-6

Cited by 5 publications

(3 citation statements)

References 8 publications

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“…The first strategy aims to map VT circuits within and adjacent to areas of scar through the use of overdrive ventricular pacing resulting in entrainment and fusion during VT (Almendral et al 1986;Stevenson et al 1993Stevenson et al , 1997Josephson et al 2014). With modern three-dimensional electro-anatomical mapping systems, an activation map can be created to define the VT circuit and complement the entrainment mapping technique while the patient is actually in VT (Potse & Essebag, 2009). The entrainment mapping approach invokes re-entry as the principal mechanism of VT and requires the VT to be haemodynamically tolerated.…”

Section: Catheter Ablation Of Ventricular Arrhythmiasmentioning

confidence: 99%

“…). With modern three‐dimensional electro‐anatomical mapping systems, an activation map can be created to define the VT circuit and complement the entrainment mapping technique while the patient is actually in VT (Potse & Essebag, ). The entrainment mapping approach invokes re‐entry as the principal mechanism of VT and requires the VT to be haemodynamically tolerated.…”

Section: Introductionmentioning

confidence: 99%

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Therapy for ventricular arrhythmias in structural heart disease: a multifaceted challenge

Proietti

Joza

Essebag

2016

The Journal of Physiology

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The unpredictable nature and potentially catastrophic consequences of ventricular arrhythmias (VAs) have obligated physicians to search for therapies to prevent sudden cardiac death (SCD). At present, a low left ventricular ejection fraction (LVEF) has been used as a risk factor to predict SCD in patients with structural heart disease and has been consistently adopted as the predominant, and sometimes sole, indication for implantable cardioverter defibrillator (ICD) therapy. Although the ICD remains the mainstay life-saving therapy for SCD, it does not modify the underlying arrhythmic substrate and may be associated with adverse effects from perioperative and long-term complications. Preventative pharmacological therapy has been associated with limited benefits, but anti-arrhythmic medications have significant side effects profiles. Catheter ablation of VAs has greatly evolved over the last few decades. Substrate mapping in sinus rhythm has allowed haemodynamically unstable VAs to be successfully treated. Both LVEF as an indication for ICD therapy and electro-anatomical mapping for substrate modification identify static components of underlying myocardial arrhythmogenicity.

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Section: Catheter Ablation Of Ventricular Arrhythmiasmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Therapy for ventricular arrhythmias in structural heart disease: a multifaceted challenge

Proietti

Joza

Essebag

2016

The Journal of Physiology

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“…At CC frequencies above 100 kHz, myocardial tissue is therefore more likely to be burned before it is excited [8]. Note that cardiac ablation is routinely performed in humans using 500 kHz and rarely induces VF [8,55]. Taking that into account IEC [15] introduced the so-called frequency factor,…”

Section: Hcf Frequency Dependencymentioning

confidence: 99%

Computational models for contact current dosimetry at frequencies below 1 MHz

Schneeweiss

Panescu

Stunder

et al. 2020

Med Biol Eng Comput

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Electric contact currents (CC) can cause muscle contractions, burns, or ventricular fibrillation which may result in life-threatening situations. In vivo studies with CC are rare due to potentially hazardous effects for participants. Cadaver studies are limited to the range of tissue’s electrical properties and the utilized probes’ size, relative position, and sensitivity. Thus, the general safety standards for protection against CC depend on a limited scientific basis. The aim of this study was therefore to develop an extendable and adaptable validated numerical body model for computational CC dosimetry for frequencies between DC and 1 MHz. Applying the developed model for calculations of the IEC heart current factors (HCF) revealed that in the case of transversal CCs, HCFs are frequency dependent, while for longitudinal CCs, the HCFs seem to be unaffected by frequency. HCFs for current paths from chest or back to hand appear to be underestimated by the International Electrotechnical Commission (IEC 60479-1). Unlike the HCFs provided in IEC 60479-1 for longitudinal current paths, our work predicts the HCFs equal 1.0, possibly due to a previously unappreciated current flow through the blood vessels. However, our results must be investigated by further research in order to make a definitive statement. Contact currents of frequencies from DC up to 100 kHz were conducted through the numerical body model Duke by seven contact electrodes on longitudinal and transversal paths. The resulting induced electric field and current enable the evaluation of the body impedance and the heart current factors for each frequency and current path.

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A classification scheme for ventricular arrhythmias using wavelets analysis

Balasundaram

Massé

Nair

et al. 2012

Med Biol Eng Comput

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Identification and classification of ventricular arrhythmias such as rhythmic ventricular tachycardia (VT) and disorganized ventricular fibrillation (VF) are vital tasks in guiding implantable devices to deliver appropriate therapy in preventing sudden cardiac deaths. Recent studies have shown VF can exhibit strong regional organizations, which makes the overlap zone between the fast paced rhythmic VT and VF even more ambiguous. Considering that implantable cardioverter-defibrillator (ICD) are primarily rate dependent detectors of arrhythmias and that there may be patients who suffer from arrhythmias that fall in the overlap zone, it is essential to identify the degree of affinity of the arrhythmia toward VT or organized/disorganized VF. The method proposed in this work better categorizes the overlap zone using Wavelet analysis of surface ECGs. Sixty-three surface ECG signal segments from the MIT-BIH database were used to classify between VT, organized VF (OVF), and disorganized VF (DVF). A two-level binary classifier was used to first extract VT with an overall accuracy of 93.7% and then the separation between OVF and DVF with an accuracy of 80.0%. The proposed approach could assist clinicians to provide optimal therapeutic solutions for patients in the overlap zone of VT and VF.

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Guidance for catheter ablation of ventricular arrhythmia

Cited by 5 publications

References 8 publications

Therapy for ventricular arrhythmias in structural heart disease: a multifaceted challenge

Therapy for ventricular arrhythmias in structural heart disease: a multifaceted challenge

Computational models for contact current dosimetry at frequencies below 1 MHz

A classification scheme for ventricular arrhythmias using wavelets analysis

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