Noncontact mapping of small pulmonary artery potentials preceding ectopy from the right ventricular outflow tract

Whitwam, Wayne; Rule, Stephen; Narayan, Sanjiv M.

doi:10.1016/j.hrthm.2007.01.026

Cited by 10 publications

(13 citation statements)

References 16 publications

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“…The balloon may be safely advanced through the pulmonary valve to accurately map foci in this location. As recently reported by Whitwam et al, 9 we also successfully mapped and ablated ectopic foci above the pulmonary valve in regions with very small potentials and the inability to pace the right ventricle. Cryoablation was used in these 4 cases with complete procedural success achieved in 3.…”

Section: Points Specific To Chamber Of Originsupporting

confidence: 57%

Cardiac Arrhythmia Management using a Noncontact Mapping Multielectrode Array

Catanchin¹,

Liew²,

Behr³

et al. 2010

Clinical Cardiology

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Background:The multielectrode array (MEA) enables noncontact mapping of cardiac arrhythmias; our experience is reviewed and reported. Hypothesis: The MEA has a role as first line therapy in multiple arrhythmias. Methods: Retrospective and prospective analysis of all consecutive cases performed using the MEA over a 6 year period. Results: Electrophysiological study and catheter ablation, 46% under general anaesthesia, using radiofrequency (RF), cryothermal and low energy direct current (DC) was performed in 66 procedures on 31 females and 29 males, average age 50.2 yrs (19.3-81.6); 8 patients underwent multiple procedures. 24 patients (36%) had undergone past ablation for the same arrhythmia. A wide variety of arrhythmias from all chambers were treated, majority right atrial (56%) and right ventricular (29%). Procedural success was complete in 77.4% and partial/indeterminate in 11.3%, highest in right atrial tachycardia, right ventricular outflow tract ectopy and typical atrial flutter (79, 82 and 100%). RF energy was most commonly used (67%) and DC carried 100% success. Ablation was delivered at 'early activation' and 'breakout' in focal arrhythmias. In re-entrant circuits linear ablation transectingpath of activation extending to regions of functional/anatomic block was performed. Two of 7 complications were attributed to the MEA: groin haematomas. At mean 12.4 mo follow up 56% were arrhythmia free, 15% asymptomatic or minimally symptomatic and 12 patients had new arrhythmias. Conclusions: The MEA is effective, safe and suitable for first line therapy in multiple cardiac arrhythmias particularly in the right heart. Further study is warranted comparing it to other mapping techniques.

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Section: Points Specific To Chamber Of Originsupporting

confidence: 57%

Cardiac Arrhythmia Management using a Noncontact Mapping Multielectrode Array

Catanchin¹,

Liew²,

Behr³

et al. 2010

Clinical Cardiology

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“…Indeed, a correlation of myocardial extent with electrophysiological features has never been validated. There have been reported cases of ventricular arrhythmias mapped and ablated well beyond the PV, within the pulmonary artery (PA) [4][5][6][7] ; in these cases, confirmation of the supravalvular site of the arrhythmia was confirmed by pulmonary angiography. However, the true incidence of supravalvular arrhythmia foci is not known, because the PV is not seen with standard fluoroscopy, and contrast visualization of the PV is not routinely obtained during electrophysiology procedures.…”

mentioning

confidence: 99%

Ubiquitous Myocardial Extensions Into the Pulmonary Artery Demonstrated by Integrated Intracardiac Echocardiography and Electroanatomic Mapping

Liu

Cheung

Thomas

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Background-Idiopathic ventricular arrhythmias of left bundle branch block inferior axis morphology are usually localized to the right ventricular outflow tract (RVOT), presumably below the pulmonic valve (PV). However, the PV location is usually not confirmed by direct visualization. Methods and Results-Intracardiac echocardiography was used to visualize and tag the PV annulus, which was then integrated with 3-dimensional voltage maps of the RVOT. Distances were measured from the furthest extent of myocardial signal (bipolar voltage ≥1.5 mV) to the PV annulus. This was performed in 24 control patients and 24 prospective patients with RVOT arrhythmias. Myocardial signal beyond the PV was found in 92% of controls and 88% of RVOT arrhythmia patients (P=1.000). Average myocardial extension was further on the septal side than on the free wall side for control patients (5.6 mm; interquartile range [IQR], 3.6-7.7, versus 1.7 mm; IQR (−)0.1 to (+)4.0; P=0.002) and RVOT arrhythmia patients (5.7 mm; IQR, 2.7-7.7, versus 1.4 mm; IQR, (−)0.8 to (+)4.8; P=0.004). Eleven (46%) RVOT arrhythmia foci were localized beyond the valve in the pulmonary artery (median 8.2 mm above PV; IQR, 6.6-10.3 mm); these locations were confirmed as supravalvular by direct intracardiac echocardiography visualization. Conclusions-Myocardial voltage extension into the pulmonary artery in humans is ubiquitous and can be demonstrated in vivo using 3-dimensional integrated intracardiac echocardiography to localize the PV. These extensions frequently serve as origins of presumed RVOT arrhythmias; intracardiac echocardiography localization of the PV allows reclassification of these as pulmonary arterial arrhythmias. (Circ Arrhythm Electrophysiol. 2014;7:691-700.)

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“…Treatment of RVOT‐derived arrhythmias with radiofrequency catheter ablation (RFCA) have been reported in numerous clinical studies. Although there are relatively few reports of treatments for pulmonary VA, the electrocardiography (ECG) and electrophysiological characteristics of radiofrequency ablation target sites as well as prognosis of patients with pulmonary VA in recent years have been reported recently . This information has important reference value.…”

Section: Introductionmentioning

confidence: 99%

“…Most are derived from the right ventricular outflow tract (RVOT), [1][2][3][4][5] and only a few are derived from the pulmonary artery. [6][7][8][9][10][11][12][13] Radiofrequency ablation is an effective treatment for idiopathic VA and is superior to drug therapy in terms of relieving symptoms and improving the quality of life. [14][15][16] Treatment of RVOTderived arrhythmias with radiofrequency catheter ablation (RFCA) have been reported in numerous clinical studies.…”

Section: Introductionmentioning

confidence: 99%

“…Although there are relatively few reports of treatments for pulmonary VA, the electrocardiography (ECG) and electrophysiological characteristics of radiofrequency ablation target sites as well as prognosis of patients with pulmonary VA in recent years have been reported recently. [6][7][8][9][10][11][12][13] This information has important reference value. conventional ablation in 15 patients with PSC-derived VA according to their origins.…”

Section: Introductionmentioning

confidence: 99%

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