Use of Adenosine to Release an Entrapped Catheter During Ablation of Premature Ventricular Complexes.
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ABSTRACT:
SUBMITTER: Kim EJ
PROVIDER: S-EPMC8302799 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundPatients undergoing ablation of premature ventricular complexes (PVCs) can have cardiac scar. Risk factors for the presence of scar are not well defined.ObjectivesTo determine the prevalence of scarring detected by delayed enhancement cardiac magnetic resonance imaging (DE-CMR) in patients undergoing ablation of PVCs, to create a risk score predictive of scar, and to explore correlations between the scoring system and long-term outcomes.MethodsDE-CMR imaging was performed in consecutive patients with frequent PVCs referred for ablation. The full sample was used to develop a prediction model for cardiac scar based on demographic and clinical characteristics, and internal validation of the prediction model was done using bootstrap samples.ResultsThe study consisted of 333 patients (52% male, aged 53.2 ± 14.5 years, preablation ejection fraction 50.9% ± 12.2%, PVC burden 20.7 ± 13.14), of whom 112 (34%) had DE-CMR scarring. Multiple logistic regression analysis showed age (odds ratio [OR] 1.02 [1.01-1.04]/year, P = .019) and preablation ejection fraction (OR 0.92 [0.89-0.94]/%, P < .001) to be predictive of scar. A weighted risk score incorporating age and ejection fraction was used to stratify patients into low-, medium-, and high-risk groups. Scar prevalence was around 86% in the high-risk group and 12% in the low-risk group; high-risk patients had worse survival free of arrhythmia.ConclusionsCardiac scar was present in one-third of patients referred for PVC ablation. A weighted risk score based simply on patient age and preprocedural ejection fraction can help discriminate between patients at high and low risk for the presence of cardiac scar and worse arrhythmia outcomes.
| S-EPMC8183950 | biostudies-literature
Project description:IntroductionThere has been limited reports about the comorbid premature ventricular contractions (PVCs) and vasovagal syncope (VVS). Deceleration capacity (DC) was demonstrated to be a quantitative evaluation to assess the cardiac vagal activity. This study sought to report the impact of autonomic modulation on symptomatic PVCs in VVS patients.Methods and resultsTwenty-six VVS patients with symptomatic idiopathic PVCs were consecutively enrolled. Identification and catheter ablation of left atrial ganglionated plexi (GP) and PVCs were performed in 26 and 20 patients, respectively. Holter 24 h-electrocardiograms were performed before and after the procedure to evaluate DC and PVCs occurrence. Eighteen patients were subtyped as DC-dependent PVCs (D-PVCs) and eight as DC-independent PVCs groups (I-PVCs). In D-PVCs group, circadian rhythm of hourly PVCs was positively correlated with hourly DC (P < 0.05) while there was no correlation in I-PVCs group (P > 0.05). Fifty-three GPs with positive vagal response were successfully elicited (2.0 ± 0.8 per patient). PVCs failed to occur spontaneously nor to be induced in six patients. In the remaining 20 patients, PVCs foci identified were all located in the ventricular outflow tract region. Post-ablation DC decreased significantly from baseline (P < 0.05). During mean follow-up of 10.64 ± 6.84 months, syncope recurred in one patient and PVCs recurred in another. PVCs burden of the six patients in whom neither catheter ablation nor antiarrhythmic drugs were applied demonstrated a significant decrease during follow-up (P = 0.037).ConclusionAutonomic activities were involved in the occurrence of symptomatic idiopathic PVCs in some VVS patients. D-PVCs might be facilitated by increased vagal activities. Catheter ablation of GP and PVCs foci may be an effective, safe treatment in patients with concomitant VVS and idiopathic PVCs.
| S-EPMC8126685 | biostudies-literature
Project description:BACKGROUND:Radiofrequency catheter ablation is approved effective therapy for premature ventricular contraction. However, the rare but serious complication such as pseudoaneurysm should be given more attention. It is life-threatening due to the high risk of rupture. Only few cases have been reported in the literature. We herein report a huge acute left ventricular pseudoaneurysm after catheter ablation therapy. CASE PRESENTATION:A 69-year-old man underwent radiofrequency catheter ablation for premature ventricular contraction at a local hospital. The patient developed shock the second day after ablation. A chest computed tomography (CT) scan showed pericardial effusion. Pericardiocentesis was performed, and the puncture fluid was a bloody pericardial effusion. The transthoracic echocardiogram revealed an 9-?×?4-cm giant pseudoaneurysm with a cystic structure in the left ventricular inferior wall near the mitral annulus along the left atrium. The pseudoaneurysm was connected to the left ventricular cavity through a 8-mm neck, and the lumen was filled with systolic and diastolic blood flow. The patient underwent three-dimensional transesophageal echocardiography. The pseudoaneurysm and the tract was clearly visible. Emergency surgery was performed to resect the pseudoaneurysm. A bovine pericardial patch was placed on the neck of the pseudoaneurysm. Echocardiographic examination confirmed the absence of cardiac lesions after the operation. CONCLUSIONS:It is rare to see such a large pseudoaneurysm after radiofrequency catheter ablation. Clinicians should be allert to the potential risks to patients in the process of an effective treatment. Echocardiography plays an important role in the prompt diagnosis and prognosis of this disease. Emergency surgery is a better method for treatment of huge pseudoaneurysm.
| S-EPMC6610948 | biostudies-literature
Project description:A 77-year-old man with ischemic cardiomyopathy and a cardiac resynchronization therapy-defibrillator (CRT-D) device came to our attention due to incessant ventricular tachycardia and multiple implantable cardioverter defibrillator (ICD) shocks. An electrocardiogram showed non-sustained monomorphic ventricular tachycardias (NSVTs) constantly occurring after each biventricular stimulation. During an electrophysiological study, NSVTs reproducibly recurred only after right ventricular (RV) pacing; LV pacing did not induce any NSVTs. The activation map was consistent with a localized reentry at the interventricular septum, and a double exit; at the LV exit site, a single radiofrequency energy application immediately interrupted the occurrence of the NSVTs. Current evidence supports LV pacing to be pro-arrhythmogenic in few CRT patients. This unusual case shows that RV pacing during CRT could produce frequent ventricular arrhythmias and arrhythmic storm. Catheter ablation can be considered an effective therapeutic option, especially when CRT maintenance is highly advisable.
| S-EPMC4672078 | biostudies-literature
Project description:BackgroundRemote magnetic navigation (RMN) is often used in combination with a 3-dimensional mapping system to perform catheter ablations. This study aim to investigate the feasibility and effectiveness of a novel 3D-mapping system, EnSite Precision, combined with RMN for catheter ablation of premature ventricular contractions (PVCs), and compared it to the procedures performed by CARTO3 with RMN.MethodsForty-three consecutive PVC patients were either ablated with the guidance of EnSite Precision (n = 22) or CARTO (n = 21) navigated by RMN. Procedure-related details, acute and long-term success were assessed.ResultsPatient characteristics between both the groups were similar (age: 47.1 ± 19.8 vs 47.1 ± 12.7, female: 63.6% vs 57.1%). No significant difference was found in the procedure time (99.5 ± 30.4 vs 92.9 ± 24.8 min, P = 0.436), mapping time (18.6 ± 12.8 vs 15.5 ± 10.2 min, P = 0.390), radiofrequency ablation time (333.4 ± 267.0 vs 469.3 ± 343.1 s, P = 0.154), fluoroscopy time (4.0 ± 1.9 vs 3.8 ± 2.0 min, P = 0.635), and X-ray dose (1.8 ± 1.4 vs 2.0 ± 1.2 Gycm2, P = 0.649) between the two groups. No significant procedural complication occurred in either group. In addition, there was no significant differences regarding the acute success rate (90.9% vs 90.5%, P = 0.961) and long-term success rate (86.4% vs 81.0%, P = 0.631) after 16.2 ± 6.2 months of follow-up between the two groups.ConclusionsRMN combined with EnSite Precision mapping system is effective and safe for catheter ablation of PVCs.
| S-EPMC6457387 | biostudies-literature
Project description:IntroductionVentricular perforation during radiofrequency ablation of ventricular tachycardia is a recognized serious complication that carries high morbidity and mortality. Perforation is often associated with local intramyocardial injury due to excess heat induced by catheter, 'steam pop'. The complication usually requires emergency surgical repair.Case presentationWe present a case, when the catheter found its way into the epicardium during left ventricular (LV) electroanatomic mapping without any serious complication. Angiography through the ablation catheter confirmed the diagnosis of LV coronary sinus fistula.DiscussionContrast injection through the irrigation port of the ablation catheter is a useful way of delineating anatomical anomalies during electrophysiology procedure.
| S-EPMC6426018 | biostudies-literature
Project description:BackgroundCatheter ablation of premature ventricular complexes from aortic sinus cusps (ASC-PVC) is a complex procedure that conventionally requires coronary catheterization (CC) to localize coronary artery ostium (CAO). Little published information is available on the mapping and ablation with zero-fluoroscopy (ZF) of ASC-PVC. The aim of the study was to determine the efficacy and safety of ASC-PVC ablation with a ZF approach guided by 3D intracardiac echocardiography integration in the electroanatomical mapping system (ICE 3D-EAM).MethodsThis observational study included one patient cohort treated conventionally and another treated with ICE 3D-EAM-guided ZF ablation. Clinical, efficacy, and safety outcomes were evaluated acutely and at 3 months follow-up.ResultsThe study included 21 patients with ASC-PVC: 10 in the ZF group (age 49 ± 16 years, 60% males) and 11 in the control group (age 47 ± 15 years, 27% males). Fluoroscopy was not required for any patient in the ZF group. Acute success was obtained in 80% of the ZF group vs 55% of the control group (P = .36). The recurrence rate was 30% in the ZF group vs 27% in the control group (P = 1). One nonsevere complication was observed in the ZF group (P = .48).ConclusionsZF catheter ablation of ASC-PVC guided by ICE 3D-EAM is feasible, effective, and safe.
| S-EPMC8637083 | biostudies-literature
Project description:Recent studies have demonstrated the utility of cardiac sympathetic denervation (CSD) in patients with ventricular tachycardia (VT) refractory to antiarrhythmic drugs and catheter or surgical ablation. We present our experience with bilateral CSD in a patient with a recurrent VT despite attempts at treatment with catheter ablation and antiarrhythmic drugs, and this is the first description of the successful management of an idiopathic refractory VT with a bilateral CSD and concomitant oral amiodarone, occurring after catheter ablation of persistent atrial fibrillation and idiopathic outflow tract premature ventricular contractions.
| S-EPMC6457378 | biostudies-literature
Project description:Idiopathic ventricular arrhythmias originating from the aortic sinus of Valsalva often show preferential conduction to the right-ventricular outflow tract, which may render radiofrequency ablation more difficult. We describe a patient with symptomatic premature ventricular contractions of left-ventricular outflow tract origin presenting with a variation of QRS morphology during ablation. The correlation between the characteristics of local voltage potentials and the real origin site of the ventricular arrhythmia is discussed.
| S-EPMC6916391 | biostudies-literature
Project description:A 17-year-old woman presented with frequent palpitations and shortness of breath and was diagnosed with drug-refractory ventricular parasystole. We predicted that the parasystole originated from the left anterior fascicle (LAF). Detailed activation maps of both conduction systems, including the LAF, during sinus rhythm and ventricular parasystole were obtained using a parallel mapping system. We confirmed the earliest fascicular potential of the parasystole and performed catheter ablation with no complications. This novel mapping algorithm for simultaneous acquisition of multiple maps aided effective treatment of ventricular parasystole originating from the LAF.
| S-EPMC7411214 | biostudies-literature