Selecting the Appropriate Ablation Strategy: the Role of Endocardial and/or Epicardial Access

Njeim, Mario; Bogun, Frank

doi:10.15420/aer.2015.4.3.184

Cited by 5 publications

(5 citation statements)

References 49 publications

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“…Until this time, the epicardial space was not utilized for mapping and ablation of VT. Since then, the epicardial mapping and ablation are becoming increasingly important in the catheter ablation of VT in both ischemic and nonischemic cardiomyopathies . While success rates for epicardial ablation have improved outcomes, the associated complication rates continue to range between 4% and 10%, including significant pericardial bleeding, inadvertent right ventricular (RV) puncture, and emergent cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

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Anterior pericardial access to facilitate electrophysiology study and catheter ablation of ventricular arrhythmias: A single tertiary center experience

Keramati

DeMazumder

Misra

et al. 2017

Cardiovasc electrophysiol

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Introduction Epicardial ablation is becoming an important part of management in patients with ventricular tachycardia (VT). Posterior epicardial access via the Sosa or needle-in-needle (NIN) approach for epicardial VT ablation is considered to be the method of choice for most electrophysiologists. Anterior epicardial access as an alternative technique has recently been proposed, but there are limited data about its safety, efficacy, and the rate of immediate complications. In this study, we report our experience with anterior epicardial access between 2009 and 2016. Methods Between 2009 and June 2016, 100 consecutive patients underwent epicardial VT ablation using an anterior approach. The success rate, epicardial bleeding, and other complications related to the epicardial access in these patients were compared to the previously reported rate of complications in patients whom epicardial access was performed using the NIN or Sosa techniques. Results Anterior epicardial access was obtained successfully in 100% of patients in the first attempt. The success rate of the anterior approach was comparable with the reported success rate of the NIN technique (100% vs. 100%, P value not significant) but better than the Sosa technique (100% vs. 94%, P = 0.012). None of the patients in the anterior approach series suffered from significant pericardial bleeding (defined as greater than 80 mL of blood loss), RV puncture/damage, or need for an emergent cardiac surgery. Conclusion An anterior epicardial approach is feasible and appears to have an acceptable safety profile in comparison with other epicardial approaches.

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Section: Introductionmentioning

confidence: 99%

“…In the 1990s, Sosa et al described the cardiomyopathies. [3][4][5][6][7][8] While success rates for epicardial ablation have improved outcomes, 3 the associated complication rates continue to range between 4% and 10%, 3,9 including significant pericardial bleeding, inadvertent right ventricular (RV) puncture, and emergent cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

Anterior pericardial access to facilitate electrophysiology study and catheter ablation of ventricular arrhythmias: A single tertiary center experience

Keramati

DeMazumder

Misra

et al. 2017

Cardiovasc electrophysiol

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“…Access via an epicardial approach can be achieved through ports in the intercostal spaces ( 1B ), a sub-xiphoid puncture ( 2B ) or via open heart surgery ( 3B ). The choice made between the two approaches is often made in relation to the target area and patient’s disease substrate [ 10 ].…”

Section: Figurementioning

confidence: 99%

Ablation Modalities for Therapeutic Intervention in Arrhythmia-Related Cardiovascular Disease: Focus on Electroporation

McBride

Avazzadeh

Wheatley

et al. 2021

JCM

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Targeted cellular ablation is being increasingly used in the treatment of arrhythmias and structural heart disease. Catheter-based ablation for atrial fibrillation (AF) is considered a safe and effective approach for patients who are medication refractory. Electroporation (EPo) employs electrical energy to disrupt cell membranes which has a minimally thermal effect. The nanopores that arise from EPo can be temporary or permanent. Reversible electroporation is transitory in nature and cell viability is maintained, whereas irreversible electroporation causes permanent pore formation, leading to loss of cellular homeostasis and cell death. Several studies report that EPo displays a degree of specificity in terms of the lethal threshold required to induce cell death in different tissues. However, significantly more research is required to scope the profile of EPo thresholds for specific cell types within complex tissues. Irreversible electroporation (IRE) as an ablative approach appears to overcome the significant negative effects associated with thermal based techniques, particularly collateral damage to surrounding structures. With further fine-tuning of parameters and longer and larger clinical trials, EPo may lead the way of adapting a safer and efficient ablation modality for the treatment of persistent AF.

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“…For example, the prevalence of epicardial focal ventricular tachycardia (VT) is around 7–13% of all focal VTs (Sacher et al 2008; Tada et al 2001). Radio-frequency (RF) catheter ablation for the treatment of VT, introduced in the early 1980s, has become one of the main options available to treat VT and successful ablation will hinge on correctly determining the site of origin of the arrhythmia (Njeim and Bogun 2015). The 12-lead electrocardiogram (ECG) is used for initial diagnostic and may show characteristics to enable physicians to infer the location of the origin, although the criteria seem to be limited (Bazan et al 2007; Berruezo et al 2004).…”

Section: Introductionmentioning

confidence: 99%

Non-invasive Characterization of Focal Arrhythmia with Electromechanical Wave Imaging in Vivo

Costet

Wan

Melki

et al. 2018

Ultrasound in Medicine & Biology

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There is currently no established method for the non-invasive characterization of arrhythmia and differentiation between endocardial and epicardial triggers at the point of care. Electromechanical wave imaging (EWI) is a novel ultrasound-based imaging technique based on time-domain transient strain estimation that can map and characterize electromechanical activation in the heart in vivo. The objectives of this initial feasibility study were to determine that EWI is capable of differentiating between endocardial and epicardial sources of focal rhythm and, as a proof-of-concept, that EWI could characterize focal arrhythmia in one patient with premature ventricular contractions (PVCs) before radiofrequency (RF) ablation treatment. First, validation of EWI for differentiation of surface of origin was performed in seven (n = 7) adult dogs using four epicardial and four endocardial pacing protocols. Second, one (n = 1) adult patient diagnosed with PVC was imaged with EWI before the scheduled RF ablation procedure, and EWI results were compared with mapping procedure results. In dogs, EWI was capable of detecting whether pacing was of endocardial or epicardial origin in six of seven cases (86% success rate). In the PVC patient, EWI correctly identified both regions and surface of origin, as confirmed by results from the electrical mapping obtained from the RF ablation procedure. These results reveal that EWI can map the electromechanical activation across the myocardium and indicate that EWI could serve as a valuable pre-treatment planning tool in the clinic.

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Selecting the Appropriate Ablation Strategy: the Role of Endocardial and/or Epicardial Access

Cited by 5 publications

References 49 publications

Anterior pericardial access to facilitate electrophysiology study and catheter ablation of ventricular arrhythmias: A single tertiary center experience

Anterior pericardial access to facilitate electrophysiology study and catheter ablation of ventricular arrhythmias: A single tertiary center experience

Ablation Modalities for Therapeutic Intervention in Arrhythmia-Related Cardiovascular Disease: Focus on Electroporation

Non-invasive Characterization of Focal Arrhythmia with Electromechanical Wave Imaging in Vivo

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