Transapical Left Ventricular Access for Ventricular Tachycardia Ablation in Patients With Mechanical Aortic and Mitral Valve Prosthesis

Yorgun, Hikmet; Canpolat, Uğur; Nof, Eyal; Beinart, Roy; Aydın, Ahmet; Sabuncu, Timuçin; Aytemir, Kudret

doi:10.1161/circep.120.008893

Cited by 10 publications

(14 citation statements)

References 5 publications

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“…Santangeli et al 16 reported a novel approach of VAs ablation by percutaneous trans‐right atrial access to LV. Other recently described approaches include percutaneous interventricular trans‐septal puncture technique, 17–19 trans‐apical approach, 20–22 and trans‐coronary mapping and chemical ablation 23 …”

Section: Discussionmentioning

confidence: 99%

Ventricular arrhythmia ablation in the presence of mechanical valve utilization and complications of catheter ablation for ventricular arrhythmia in patients with mechanical prosthetic valves

Rozen

Elbaz‐Greener

Andria

et al. 2021

Cardiovasc electrophysiol

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Background Catheter ablation (CA) for ventricular arrhythmias (VAs) is increasingly utilized in recent years. We aimed to investigate the nationwide trends in utilization and procedural complications of CA for VAs in patients with mechanical valve (MV) prosthesis. Methods We drew data from the US National Inpatient Sample database to identify cases of VA ablations, including premature ventricular contraction and ventricular tachycardia, in patients with MVs, between 2003 and 2015. Sociodemographic and clinical data were collected and the incidence of catheter ablation complications, mortality, and length of stay were analyzed. We compared the outcomes to a propensity‐matched cohort of patients without prior valve surgery. Results The study population included a weighted total of 647 CA cases in patients with prior MVs. The annual number of ablations almost doubled, from 34 ablations on average during the “early years” (2003–2008) to 64 on average during the “late years” (2009–2015) of the study (p = .001). Length of stay at the hospital did not differ significantly between patients with MVs and 649 matched patients without prior MVs (5.4 ± 0.4, 4.7 ± 0.3 days, respectively, p = .12). The data revealed a trend toward a higher incidence of complications (12.6% vs. 7.5% respectively, p = .14) and mortality (3.7% vs. 0.7%, respectively, p = .087) among patients with MVs compared to the matched control group, not reaching statistical significance. Conclusion The data show increased utilization of VA ablations in patients with MVs and a trend toward a higher incidence of in‐hospital mortality and complications compared to the propensity‐matched control group without MVs.

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Section: Discussionmentioning

confidence: 99%

Ventricular arrhythmia ablation in the presence of mechanical valve utilization and complications of catheter ablation for ventricular arrhythmia in patients with mechanical prosthetic valves

Rozen

Elbaz‐Greener

Andria

et al. 2021

Cardiovasc electrophysiol

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“…A prior case series that utilized both percutaneous transapical LV access and surgical access noted a significant drawback with surgical access because of weak tissue support from the LV myocardium, which could lead to sheath dislodgement. 8 This is indeed a possibility, though in our case we stabilized the sheath manually throughout the case, rendering the risk of sheath dislodgement negligible. Although this may be cumbersome, we believe that this is far outweighed by the risks and high incidence of adverse outcomes of a percutaneous approach.…”

Section: Discussionmentioning

confidence: 92%

Combined endocardial and epicardial ablation of drug-refractory ventricular tachycardia by direct ventricular puncture

Ashraf

Minaskeian

Sell-Dotin

et al. 2021

HeartRhythm Case Reports

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…Unlike in patients with ventricular arrhythmias, in whom the presence of MPVs can affect the approach to the chamber of interest, to avoid passing through a prosthetic valve, 24–26 the access into the left atrium, via the interatrial septum is similar between patients with or without mechanical prosthetic valves. However, even when access to the left atrium is safely achieved, the ablation procedure is still more challenging since in some of the cases, like in patients with mechanical mitral prosthesis, cautions should be taken when mapping and ablating the peri‐annular region because of the risk of catheter entrapment and periprocedural cerebrovascular accident 16,17 .…”

Section: Discussionmentioning

confidence: 99%

Safety of catheter ablation for atrial fibrillation in patients with mechanical prosthetic valves

Rozen

Elbaz‐Greener

Andria

et al. 2022

Cardiovasc electrophysiol

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Background Catheter ablation (CA) for atrial fibrillation (AF) is increasingly utilized in recent years, with promising results. We aimed to investigate the nationwide trends in utilization and procedural complications of CA for AF in patients with mechanical prosthetic valves (MPVs). Methods and Results We drew data from the US National Inpatient Sample (NIS) database to identify cases of AF ablations in patients with MPVs, between 2003 and 2015. Sociodemographic and clinical data were collected, and incidence of procedural complications, mortality, and length of stay were analyzed. We compared the outcomes to a propensity‐matched cohort of patients without MPVs. The study included a weighted total of 1898 CA for AF cases in patients with MPVs. The median age of the study population was 67 (61–75) years and 53% were males. Despite the increasing age and significant uptrend in the prevalence of individual comorbidities and Deyo–Charlson Comorbidity Index (CCI) over the years, the risk of peri‐procedural complications and mortality in the study group did not change between the early (2003–2008) and late (2009–2015) study years. The peri‐procedural complication rate (8.4% vs. 10.4%, p = .33) and in‐hospital mortality (0.2% vs. 0.2%, p = .9) did not differ significantly between patients with MPVs and 1901 matched patients without MPVs. Length of stay was higher among patients with prior MPVs compared to the controls (4.0 ± 0.2 vs. 3.3 ± 0.2 days, p = .011). Conclusion This nationwide analysis shows that AF ablation in patients with mechanical valve prothesis bares a similar risk of periprocedural complications and mortality as in patients without prosthetic valves.

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Transapical Left Ventricular Access for Ventricular Tachycardia Ablation in Patients With Mechanical Aortic and Mitral Valve Prosthesis

Cited by 10 publications

References 5 publications

Ventricular arrhythmia ablation in the presence of mechanical valve utilization and complications of catheter ablation for ventricular arrhythmia in patients with mechanical prosthetic valves

Ventricular arrhythmia ablation in the presence of mechanical valve utilization and complications of catheter ablation for ventricular arrhythmia in patients with mechanical prosthetic valves

Combined endocardial and epicardial ablation of drug-refractory ventricular tachycardia by direct ventricular puncture

Safety of catheter ablation for atrial fibrillation in patients with mechanical prosthetic valves

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