Radiofrequency catheter ablation for treatment of premature ventricular contractions triggering ventricular fibrillation from the right ventricular outflow tract in a patient with early repolarization syndrome

Kakihara, Jun; Takagi, Masahiko; Hayashi, Yusuke; Tatsumi, Hiroaki; Doi, Atsushi; Yoshiyama, Minoru

doi:10.1016/j.hrcr.2016.04.001

Cited by 10 publications

(7 citation statements)

References 13 publications

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“…Thus far, there have Downloaded from http://ahajournals.org by on October 11, 2019 been a few case reports of successful catheter ablation of VF triggers for treatment of ERS patients with electrical storm. [7][8][9] Better characterization of the arrhythmogenic substrate and VF drivers in ERS are needed to identify targets for ablation therapy. Thus, we carried out a multicenter collaborative study aiming to map patients who experienced frequent VF episodes associated with inferolateral ER, to determine the role of catheter ablation for treatment of symptomatic ERS patients.…”

Section: Introductionmentioning

confidence: 99%

Mapping and Ablation of Ventricular Fibrillation Associated With Early Repolarization Syndrome

et al. 2019

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Background:We conducted a multicenter study to evaluate mapping and ablation of ventricular fibrillation (VF) substrates or VF triggers in early repolarization syndromes (ERS) or J-wave syndrome (JWS). Methods: We studied 52 ERS patients (4 females; median age, 35 years) with recurrent VF episodes. Body-surface electrocardiographic imaging (ECGI) along with endocardial and epicardial electroanatomic mapping of both ventricles were performed during sinus rhythm and VF for localization of triggers, substrates, and drivers. Ablations were performed on:1) VF substrates defined as areas that had late depolarization abnormalities characterized by low voltage fractionated late potentials and 2) VF triggers. Results: Fifty-one of the 52 patients had detailed mapping which revealed two phenotypes: 1) Group 1 had late depolarization abnormalities predominantly at the right ventricular (RV) epicardium (n=40); and 2) Group 2 had no depolarization abnormalities (n=11). Group 1 can be subcategorized into 2 groups: Group 1A included 33 ERS patients with Brugada ECG pattern, and Group 1B included 7 ERS patients without Brugada ECG pattern. Late depolarization areas co-localize with VF driver areas. The anterior RV outflow tract (RVOT)/RV epicardium and the RV inferior epicardium are the major substrate sites for Group 1. The Purkinje network is the leading underlying VF trigger in Group 2 that had no substrates. Ablations were performed in 43 patients: 33 and 5 Group 1 patients had only VF substrate ablation and VF substrates plus VF trigger, respectively (mean 1.4 ± 0.6 sessions); 5 Group 2 patients and 1 without group classification had only Purkinje VF trigger ablation (mean 1.2 ± 0.4 sessions). Ablations were successful in reducing VF recurrences (p<0.0001). After follow-up of 31 ± 26 months, 39 (91%) had no VF recurrences. Conclusions: There are 2 phenotypes of ERS/JWS: 1) one with late depolarization abnormality as the underlying mechanism of high amplitude J-wave elevation that predominantly resides in the RVOT and RV inferolateral epicardium, serving as an excellent target for ablation; and 2) the other with pure ERS devoid of VF substrates, but with VF triggers that are associated with Purkinje sites. Ablation is effective in treating symptomatic ERS/JWS patients with frequent VF episodes. Non-Standard Abbreviations and AcronymsVF = Ventricular fibrillation. ERS = Early repolarization syndrome. BrS = Brugada syndrome JWS = J-wave syndrome RVOT = Right ventricular outflow tract RV = Right ventricle

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Section: Introductionmentioning

confidence: 99%

Mapping and Ablation of Ventricular Fibrillation Associated With Early Repolarization Syndrome

et al. 2019

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“…Nevertheless, for ventricular fibrillation, either idiopathic or occurring in Brugada, long QT, and early repolarization syndromes, VPBs identifiable as triggers can be successfully ablated from the right ventricular outflow tract and/or the right or left Purkinje conduction system 1, 2, 3, 4, 5…”

Section: Discussionmentioning

confidence: 99%

“…In patients with no evidence for structural heart disease, idiopathic ventricular fibrillation and polymorphic ventricular tachycardia (PVT) are frequently triggered by ventricular premature beats (VPBs) arising from the Purkinje system or the right ventricular outflow tract that can be successfully eliminated by radiofrequency (RF) catheter ablation 1, 2. Such triggers of malignant arrhythmias have also been demonstrated and successfully eliminated in patients with Brugada, long QT, and early repolarization syndromes 3, 4, 5. We report a case involving a patient with Brugada syndrome in whom malignant PVT was eliminated by RF ablation of VPBs as a trigger originating from the left fascicular conduction system.…”

Section: Introductionmentioning

confidence: 99%

Catheter ablation of ventricular ectopy originating from the left fascicular conduction system triggering polymorphic ventricular tachycardia in Brugada syndrome

Hluchý

Prull

Berndt

et al. 2019

HeartRhythm Case Reports

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“…Previously considered a benign incidental ECG finding, Haïssaguerre et al (2008) and others have highlighted the association of inferolateral lead ER in patients with idiopathic VF [25,64,65]. The hallmark of malignant ER is down sloping J-point elevation present in the infero-lateral leads (Figure 8).…”

Section: Early Repolarisation (Er)mentioning

confidence: 96%

Catheter Ablation of Ventricular Fibrillation

Anderson

Kumar

Kalman

et al. 2019

Heart, Lung and Circulation

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Sudden cardiac death (SCD) is common and affects a heterogeneous group, from those with established cardiovascular disease to a population without structural heart disease and those with malignant inherited arrhythmic syndromes. Worldwide estimates are that 50% of all such deaths are linked to ventricular fibrillation (VF) [1]. In high-risk patients or resuscitated VF survivors, implantable cardiac defibrillators (ICD) are the cornerstone first-line therapy to abort further episodes [2,3]. However, ICDs do not prevent recurrent episodes and, even with antiarrhythmic therapy, up to 20% of patients with ICDs experience recurrent VF episodes and even electrical storms (multiple recurrences of ventricular arrhythmias over a short period of time), with a clear morbidity burden and increased mortality [4,5].Ventricular fibrillation (VF) is a common and life-threatening arrhythmia resulting in sudden cardiac death (SCD). Due to the inherent challenges of mapping VF in humans, the underlying mechanisms that initiate and sustain this common arrhythmia are still poorly understood. In high-risk patients and survivors of SCD, implantable cardioverter defibrillators (ICD) play a central role in treating VF episodes, however, ICDs do not prevent VF recurrences and patients remain at risk of electrical storm and multiple shocks that are often refractory to escalation of medical therapy. More recently, the utility of catheter ablation (CA) has extended to the treatment of VF storms. This review will focus on updates in elucidating the mechanism of VF leading into the role and indication of CA as a treatment strategy.

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Radiofrequency catheter ablation for treatment of premature ventricular contractions triggering ventricular fibrillation from the right ventricular outflow tract in a patient with early repolarization syndrome

Cited by 10 publications

References 13 publications

Mapping and Ablation of Ventricular Fibrillation Associated With Early Repolarization Syndrome

Mapping and Ablation of Ventricular Fibrillation Associated With Early Repolarization Syndrome

Catheter ablation of ventricular ectopy originating from the left fascicular conduction system triggering polymorphic ventricular tachycardia in Brugada syndrome

Catheter Ablation of Ventricular Fibrillation

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