Radiofrequency Catheter Ablation of Idiopathic Left Ventricular Outflow Tract Tachycardia: Utility of Intracardiac Echocardiography

Lamberti, Filippo; Calò, Leonardo; Pandozi, Claudio; Castro, Antonio; Loricchio, Maria Luisa; Boggi, Augusto; Toscano, Salvatore; Ricci, Renato Pietro; Drago, Fabrizio; Santini, Massimo

doi:10.1046/j.1540-8167.2001.00529.x

Cited by 48 publications

(26 citation statements)

References 2 publications

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“…(1) Several studies have highlighted the use of ICE in VT ablation to guide catheter placement on specific anatomic targets such as the papillary muscles, to facilitate mapping and ablation of aortic cusp VT, and to monitor lesion development. (1–4) There is limited information on the ability of ICE to assess for abnormal substrate during VT ablation. (5–7)…”

Section: Introductionmentioning

confidence: 99%

Assessing Epicardial Substrate Using Intracardiac Echocardiography During VT Ablation

Bala

Ren

Hutchinson

et al. 2011

Circ: Arrhythmia and Electrophysiology

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Background Intracardiac echocardiography (ICE) has played a limited role in defining the substrate for ventricular tachycardia (VT). The purpose of this study was to assess whether ICE could identify abnormal epicardial substrate in patients (pts) with nonischemic cardiomyopathy (NICM) and VT. Methods and Results We studied 18 pts with NICM and recurrent VT who had abnormal echogenicity identified on ICE imaging. Detailed LV endocardial (ENDO) and epicardial (EPI) electroanatomic mapping was performed in all pts. Low voltage areas (< 1.0mV) in the epicardium were analyzed. ICE imaging in the NICM group was compared to a control group of 30 pts with structurally normal hearts who underwent ICE imaging for other ablation procedures. In 18 pts (53 ± 13 years, 17 men) with NICM (EF: 37 ± 13%) increased echogenicity was identified in the lateral LV by ICE imaging. LV ENDO electroanatomic mapping identified normal voltage in 9 pts and at least one, confluent low voltage area [6.6 cm2 (minimum 2.1 to maximum 31.7 cm2)] in 9 pts (5 posterolateral LV and 4 perivalvular LV). Detailed EPI mapping revealed areas of low voltage [39 cm2 (minimum 18.5 to maximum 96.3 cm2)] and abnormal, fractionated electrograms (EGMs) in all 18 pts (15 posterolateral LV and 3 lateral LV). In all pts, the EPI scar identified by electroanatomic mapping correlated with the echogenic area identified on ICE imaging. ICE imaging identified no areas of increased echogenicity in the control group. Conclusions ICE imaging identified increased echogenicity in the lateral wall of the LV that correlated to abnormal EPI substrate. These findings suggest that ICE imaging may be useful to identify EPI substrate in NICM.

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Section: Introductionmentioning

confidence: 99%

Assessing Epicardial Substrate Using Intracardiac Echocardiography During VT Ablation

Bala

Ren

Hutchinson

et al. 2011

Circ: Arrhythmia and Electrophysiology

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“…In approximately 18% of patients, the origin of OTVT cannot be localized to either of these sites and is found to have an epicardial origin (2). Ablation of such foci is most often performed from the aortic valve cusps (AVCs), most often the left (3)(4)(5)(6).…”

mentioning

confidence: 99%

Ablation of Left Ventricular Epicardial Outflow Tract Tachycardia From the Distal Great Cardiac Vein

Obel

d’Ávila

Neužil

et al. 2006

Journal of the American College of Cardiology

116

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“…22 23 The ability of phased array ICE catheters to image left sided cardiac structures with the imaging catheter exclusively in the right heart is especially advantageous in patients with dilated ventricles, in order to evaluate the presence of intracardiac thrombus, without the need of arterial or transseptal puncture. Lamberti et al 24 have reported the use of ICE as an aid in establishing the position and stability of the ablation electrode in relation to the anatomic localisation of the VT in the LV outflow tract, thus avoiding the application of radiofrequency current to valvar leaflets and coronary arteries. Figure 7A-C demonstrates ablation of VT originating from the RV outflow tract.…”

Section: Ablation Of Ventricular Tachycardiamentioning

confidence: 99%

Clinical applications of intracardiac echocardiography in interventional procedures

Jongbloed

Schalij²,

Zeppenfeld³

et al. 2005

Heart

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A ccurate knowledge of the anatomy of intracardiac structures is essential for the efficiency and safety of performing interventional procedures. Although fluoroscopy is an important aid while advancing catheters in the heart, it is not sufficient to supply accurate anatomical information on the position of veins, ridges, and septa in the heart. Furthermore radiation exposure forms a risk to both the patient and the operator.Intracardiac echocardiography (ICE) is a promising technique for imaging of intracardiac structures, and may serve as an alternative for the transoesophageal approach, 1 which is semiinvasive and requires anaesthesiology. The introduction of ICE catheters with low frequencies allows accurate visualisation of intracardiac anatomical structures with an ultrasound catheter placed exclusively in the right side of the heart. This report focuses on the use of ICE in guiding percutaneous interventional procedures. BASICS OF INTRACARDIAC ECHOCARDIOGRAPHY cHistory of two dimensional intracardiac ultrasound systems The first application of ICE was done using mechanical ultrasound systems, which were introduced in the 1980s. These systems provided high resolution imaging, but because of the high frequency of the transducers (20-40 MHz), tissue penetration was only limited and anatomic intracardiac overviews could not be obtained. The subsequent development of lower frequency transducers allowed imaging of intracardiac structures, but these systems were still limited by the low steerability and over-the-wire design of the catheters. 2 The clinical use was improved by the development of flexible lower frequency transducers (9 MHz), but depth control of these catheters still was not sufficient to allow visualisation of the whole heart from the right side of the heart. In the 1990s, systems modified after transoesophageal echocardiographic probes were introduced. In these systems depth was improved by the use of lower frequencies (5 MHz). However, the large size of these transducers limited the clinical use. In recent years the development of steerable phased array ultrasound catheter systems with low frequency and Doppler qualities has expanded the clinical use of ICE.

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Radiofrequency Catheter Ablation of Idiopathic Left Ventricular Outflow Tract Tachycardia: Utility of Intracardiac Echocardiography

Abstract: Idiopathic VT of the LVOT can be treated successfully with RF ablation. ICE can accurately guide catheter ablation and identify anatomic landmarks, endocardial contact, and ablation electrode movement.

Cited by 48 publications

References 2 publications

Assessing Epicardial Substrate Using Intracardiac Echocardiography During VT Ablation

Assessing Epicardial Substrate Using Intracardiac Echocardiography During VT Ablation

Ablation of Left Ventricular Epicardial Outflow Tract Tachycardia From the Distal Great Cardiac Vein

Clinical applications of intracardiac echocardiography in interventional procedures

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