Radiofrequency Catheter Ablation of Ventricular Tachycardia in Patients With Hypertrophic Cardiomyopathy and Apical Aneurysm

Igarashi, Miyako; Nogami, Akihiko; Kurosaki, Kenji; Hanaki, Yuichi; Komatsu, Yuki; Fukamizu, Seiji; Morishima, Itsuro; Kaitani, Kazuaki; Nishiuchi, Suguru; Talib, Ahmed Karim; Machino, Takeshi; Kuroki, Kenji; Yamasaki, Hiro; Murakoshi, Nobuyuki; Sekiguchi, Yukio; Kuga, Keisuke; Aonuma, Kazutaka

doi:10.1016/j.jacep.2017.12.020

Cited by 48 publications

(40 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, most previous studies did not differentiate between aHCM and sHCM (46,48). In our study, the presence of LV apical aneurysm was an independent predictor of ventricular arrhythmia, which is consistent with previous reports (46,47). The presence of LV apical aneurysm is currently not part of recommended criteria for the indication of a primary prevention ICD (17,43,49).…”

Section: Discussionsupporting

confidence: 89%

See 1 more Smart Citation

Ventricular Arrhythmia in Septal and Apical Hypertrophic Cardiomyopathy: The French-Canadian Experience

Steinberg

Nadeau-Routhier

André

et al. 2020

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Background: Apical hypertrophic cardiomyopathy (aHCM) is thought to have a more benign clinical course compared to septal HCM (sHCM), but most data have been derived from Asian cohorts. Comparative data on clinical outcome in Caucasian aHCM cohorts are scarce, and the results are conflicting. The aim of this study was to estimate the prevalence and outcome of aHCM in French-Canadians of Caucasian descent. Methods and results: We conducted a retrospective, single-center cohort study. The primary endpoint was a composite of documented sustained ventricular arrhythmia (VA), appropriate ICD therapy, arrhythmogenic syncope, cardiac arrest, or all-cause mortality. A total of 301 HCM patients (65% males) were enrolled including 80/301 (27%) with aHCM and 221/301 (73%) with sHCM. Maximal wall thickness was similar in both groups. Left ventricular apical aneurysm was significantly more common in aHCM (10 vs. 0.5%; p < 0.001). The proportion of patients with myocardial fibrosis ≥ 15% of the left ventricular mass was similar between aHCM and sHCM (21 vs. 24%; p = 0.68). Secondary prevention ICDs were more often implanted in aHCM patients (16 vs. 7%; p = 0.02). The primary endpoint occurred in 26% of aHCM and 10.4% of sHCM patients (p = 0.001) and was driven by an increased incidence of sustained VA (10 vs. 2.3%; p = 0.01). Multivariate analysis identified apical aneurysm and a phenotype of aHCM as independent predictors of the primary endpoint and the occurrence of sustained ventricular tachycardia. Unexplained syncope and a family history of sudden cardiac death were additional predictors for sustained VA. Apical HCM was associated with an increased risk of ventricular arrhythmia even when excluding patients with apical aneurysm. Conclusions: The phenotype of apical HCM is much more common in French-Canadians (27%) of Caucasian descent compared to other Caucasian HCM populations. Apical HCM in French-Canadians is associated with an increased risk for ventricular arrhythmia.

show abstract

Section: Discussionsupporting

confidence: 89%

“…Therefore, the true proportion of LV apical aneurysm in our study cohort may actually be even higher. Apical aneurysm of the left ventricle has been identified as a predictor of worse prognosis and increased risk of ventricular arrhythmia in HCM (46,47). However, most previous studies did not differentiate between aHCM and sHCM (46,48).…”

Section: Discussionmentioning

confidence: 99%

Ventricular Arrhythmia in Septal and Apical Hypertrophic Cardiomyopathy: The French-Canadian Experience

Steinberg

Nadeau-Routhier

André

et al. 2020

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…The pathogenesis of apical aneurysm formation in HCM is likely multifactorial [72], but microvascular ischaemia and subsequent scar formation contribute substantially to arrhythmia risk [73]. In this setting, ventricular tachycardia (VT) is typically mapped to the heterogeneous border zone of the apical aneurysm scar [74].…”

Section: Arrhythmogenesis In Hcmmentioning

confidence: 99%

Evaluation of cardiac hypertrophy in the setting of sudden cardiac death

Cunningham

Spears

Care

2019

Forensic Sciences Research

View full text Add to dashboard Cite

Ventricular hypertrophy is a common pathological finding at autopsy that can act as a substrate for arrhythmogenesis. Pathologists grapple with the significance of ventricular hypertrophy when assessing the sudden and unexpected deaths of young people and what it could mean for surviving family members. The pathological spectrum of left ventricular hypertrophy (LVH) is reviewed herein. This article is oriented to the practicing autopsy pathologist to help make sense of various patterns of increased heart muscle, particularly those that are not clearly cardiomyopathic, yet present in the setting of sudden cardiac death. The article also reviews factors influencing arrhythmogenesis as well as genetic mutations most commonly associated with ventricular hypertrophy, especially those associated with hypertrophic cardiomyopathy (HCM).

show abstract

“…In addition, ablation has been shown to be quite effective in such patients. Several studies are showing increased success rates of VT ablation with an epicardial approach in this sub-set of patients that may be attributed to easier mapping and localization of the focus of VT, which tends to originate around the ring of the ventricular aneurysm [14,15].…”

Section: Discussionmentioning

confidence: 99%

Ventricular Tachycardia Ablation Complicated with Ventricular Rupture

Al‐Sadawi¹,

Capric²,

Budzikowski³

et al. 2019

AJMCR

View full text Add to dashboard Cite

Patients with cardiomyopathy (CM) are at increased risk for sudden cardiac death (SCD), specifically, secondary to ventricular arrhythmias such as ventricular tachycardia (VT) or ventricular fibrillation (VF). Those that have CM are further stratified based on risk of death from ventricular arrhythmias. If determined high risk, implantable cardioverter-defibrillators (ICD), anti-arrhythmic medication or even ablation procedures are considered in order to minimize the risk of SCD. Ablation procedures have increased in number over the years, along with the recognition of high-risk CM patients. Along with the increase in number of ablation procedures, complications from such procedures have decreased in number and the ventricular arrhythmia ablation remains a relatively low-risk procedure. Here we describe a patient with known CM, specifically hypertrophic cardiomyopathy (HCM) with a relatively rare and high-risk complication, being ventricular aneurysm. HCM patients with ventricular aneurysm are often referred for ablation procedures as they are at a significantly higher risk for SCD due to arrhythmias. Our patient not only underwent an ablation procedure, but suffered from the rare complication of tamponade, which occurs on average <2% annually. Although, risk assessments exist for stratifying CM as high-risk prior to invasive procedures, risk assessments are lacking for the specific population of HCM patients with LV aneurysm, thus presenting us with an area for further research.

show abstract

Radiofrequency Catheter Ablation of Ventricular Tachycardia in Patients With Hypertrophic Cardiomyopathy and Apical Aneurysm

Abstract: In patients with HCM and AA, endocardial RFCA of AA effectively suppressed monomorphic VT which was related to AA and resulted in satisfactory outcomes.

Cited by 48 publications

References 25 publications

Ventricular Arrhythmia in Septal and Apical Hypertrophic Cardiomyopathy: The French-Canadian Experience

Ventricular Arrhythmia in Septal and Apical Hypertrophic Cardiomyopathy: The French-Canadian Experience

Evaluation of cardiac hypertrophy in the setting of sudden cardiac death

Ventricular Tachycardia Ablation Complicated with Ventricular Rupture

Contact Info

Product

Resources

About