Initial Human Feasibility of Infusion Needle Catheter Ablation for Refractory Ventricular Tachycardia

Abstract

2289Background-Ablation of ventricular tachycardia (VT) is sometimes unsuccessful when ablation lesions are of insufficient depth to reach arrhythmogenic substrate. We report the initial experience with the use of a catheter with an extendable/ retractable irrigated needle at the tip capable of intramyocardial mapping and ablation. Methods and Results-Sequential consenting patients with recurrent VT underwent ablation with the use of a needletipped catheter. At target sites, the needle was advanced 7 to 9 mm into the myocardium, permitting pacing and recording. Infusion of saline/iodinated contrast mixture excluded perforation and ensured intramyocardial deployment. Further infusion was delivered before and during temperature-controlled radiofrequency energy delivery through the needle. All 8 patients included (6 male; mean age, 54) with a mean left ventricular ejection fraction of 29% were refractory to multiple antiarrhythmic drugs, and 1 to 4 previous catheter ablation attempts (epicardial in 4) had failed.Patients had 1 to 7 (median, 2) VTs present or inducible; 2 were incessant. Some intramyocardial VT mapping was possible in 7 patients. A mean of 22 (limits, 3-48) needle ablation lesions were applied in 8 patients. All patients had at least 1 VT terminated or rendered noninducible. During a median of 12 months follow-up, 4 patients were free of recurrent VT, and 3 patients were improved, but had new VTs occur at some point during follow-up. Two died of the progression of preexisting heart failure without recurrent VT. Complications included tamponade in 1 patient and heart block in 2 patients. Conclusions-Intramyocardial infusion-needle catheter ablation is feasible and permits control of some VTs that have been refractory to conventional catheter ablation therapy, warranting further study. (Circulation. 2013;128:2289-2295.)

Catheter Ablation of Ventricular Arrhythmia in Nonischemic Cardiomyopathy

“…The intramural scarring process typical of DCM does not allow the identification of VT isthmuses in many instances and also prevents effective and long-lasting lesion formation because of the limited (< 5 mm) penetration of the RF energy achieved even with irrigated catheters at high power. Although alternative energy delivery modalities have been described, including bipolar RF, 17 high-intensity focused ultrasound, 18 needle ablation, 19 or intracoronary ethanol injection, 20 none of them are currently available for routine clinical application. The data from this series should also stimulate technical and clinical research in this field.…”

Bipolar irrigated radiofrequency ablation of resistant ventricular tachycardia with a septal intramural origin: the initial experience and a description of the method

“…The efficacy of this method has been proven by several reports 13, 14. Second, a needle sliding out form ablation catheter can be used to deliver RF energy to the myocardium, although this technique is associated with a relatively high number of complications 15. Third, experimental phase bipolar ablation using two ablation electrodes positioned on the opposite side of the wall.…”

Innovations in Clinical Cardiac Electrophysiology: Challenges and Upcoming Solutions in 2018 and Beyond

“…Complications included two cases of complete heart block and one of cardiac tamponade. 79 Multiple observational clinical trials utilizing the intramural needle catheters are currently underway (eg, NCT03204981, NCT02799693, NCT01791543) and are expected to shed further light on this novel modality.…”