Left ventricular summit ablation through open sternotomy with hybrid utilization of standard electrophysiology catheters and maneuvers.
Ontology highlight
ABSTRACT:
SUBMITTER: Sriramoju A
PROVIDER: S-EPMC8767172 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:BackgroundCoronary venous ethanol ablation (VEA) can be used as a strategy to treat ventricular arrhythmias arising from the left ventricular summit, but collateral flow and technical challenges cannulating intramural veins in complex venous anatomies can limit its use. Advanced techniques for VEA can capitalize on collateral vessels between target and nontarget sites to improve success.MethodsOf 55 patients with left ventricular summit ventricular arrhythmia, advanced techniques were used in 15 after initial left ventricular summit intramural vein mapping failed to show suitable targets for single vein, single-balloon VEA. All patients had previous radiofrequency ablation attempts. Techniques included: double-balloon for distal protection to block distal flow and target the proximal portion of a large intramural vein where best signal was proximal (n=6); balloons in 2 different left ventricular summit veins for a cross-fire multivein VEA (n=4); intramural collateral vein-to-vein cannulation to reach of targeted vein via collateral with antegrade ethanol and proximal balloon block (n=2); prolonged ethanol dwell time for vein sclerosis of large intramural vein and subsequent VEA (n=3); and intramural collateral VEA (n=1).ResultsFifteen (8 females) patients (age 60.6±17.6 years) required advanced techniques. Procedure time was 210±49.9 minutes, fluoroscopy time was 25.3±14.1 minutes, and 113±17.9 cc of contrast was utilized. A median of 7 cc of ethanol was delivered (range, 4-15 cc). Intraprocedural radiofrequency ablation was delivered before ethanol in 9 out of 15 patients but failed. Ethanol achieved acute success in all 15 patients. Ethanol was used as the sole treatment in two patients. At a median follow-up of 194 days, one patient experienced recurrence.ConclusionsAdvanced techniques capitalizing on venous anatomy can enable successful VEA and selective targeting of arrhythmogenic sites, by blocking distal flow, utilization of collaterals between nontarget and target veins and multivein VEA. Understanding individual anatomy is critical for VEA success.
| S-EPMC9388546 | biostudies-literature
Project description: Not available
| S-EPMC9811025 | biostudies-literature
Project description: Not available
| S-EPMC8767176 | biostudies-literature
Project description:BackgroundAlthough premature ventricular complexes and ventricular tachycardia (VT) from outflow tracts are easy to map and ablate, some foci create the greatest challenges for the electrophysiologist. One such example is the 'Bermuda triangle' of the heart.Case summaryIn this article, we describe the rarely used but acceptable approach to the 'Bermudian' focus. We present a case of a 38-year-old male patient with sustained monomorphic VT, who underwent radiofrequency ablation of arrhythmogenic myocardium. After unsuccessful ablation through the posterior right ventricular outflow tract (RVOT), left coronary cusp (LCC), and distal coronary sinus, tachycardia was eliminated from the left atrial appendage (LAA). Complaints such as palpitations and weakness disappeared after the procedure.DiscussionRadiofrequency ablation of VT might be performed using LAA. This approach is used when the epicardial location of arrhythmia-causing tissue is suspected and ablation through the RVOT, LCC, and great cardiac vein fails.
| S-EPMC6426030 | biostudies-literature
Project description:BackgroundIdiopathic ventricular arrhythmias (IVAs) arising from different portions of the communicating vein of the left ventricular summit (summit-CV) are not a rare phenomenon. Whereas its electrocardiographic (ECG) and electrophysiological characteristics are not fully investigated.ObjectiveThis study aimed to identify distinct ECG and electrophysiological features of IVAs originating from different portions of summit-CV.MethodsNineteen patients confirmed arising from summit-CV were included in this study.ResultsThe 19 patients were divided into proximal and distal portion groups based on their target sites in summit-CV. In the proximal portion group, 100% (11/11) VAs showed dominant negative (rs or QS) waves in lead I, while in the distal portion group, 87.5% (7/8) showed dominant positive waves (R, Rs or r) (p < 0.000). In lead V1, 100% (11/11) of the proximal portion group showed dominant positive waves (R or Rs), while 62.50% (5/8) of the distal portion group showed positive and negative bidirectional or negative waves (RS or rS) (p < 0.005). RI>4mV, SI<3.5mV, RV1<13mV, SV1>3.5mV, RI/SI>0.83, and RV1/SV1< 2.6 indicated a distal portion of summit-CV with the predictive value of 0.909, 1.000, 0.653, 0.972, 0.903, 0.966, respectively. A more positive wave in lead I and a more negative wave in lead V1 indicated more distal origin in summit-CV. Target sites in proximal and distal summit-CV groups showed similar electrophysiological characteristics during mapping.ConclusionsThere were significant differences in ECG characteristics of VAs at different portions of summit-CV, which could aid pre-procedure planning and facilitate radiofrequency catheter ablation (RFCA) procedures.
| S-EPMC11320958 | biostudies-literature
Project description:Radiofrequency (RF) ablation with irrigated tip catheters decreases the likelihood of thrombus and char formation and enables the creation of larger lesions. Due to the potential dramatic consequences, the prevention of thromboembolic events is of particular importance for left-sided procedures. Although acute success rates of ventricular tachycardia (VT) ablation are satisfactory, recurrence rate is high. Apart from the progress of the underlying disease, reconduction and the lack of effective transmural lesions play a major role for VT recurrences. This paper reviews principles of lesion formation with radiofrequency and the effect of tip irrigation as well as recent advances in new technology. Potential areas of further development of catheter technology might be the improvement of mapping by better substrate definition and resolution, the introduction of bipolar and multipolar ablation techniques into clinical routine, and the use of alternative sources of energy.
| S-EPMC4326034 | biostudies-literature
Project description:BackgroundSustained forms of tachycardia especially from the left ventricular summit are rare. Adenosine sensitive outflow tachycardias, especially from the left ventricular summit, are rarer still. These arrhythmias may be exercise or stress induced as they are facilitated by catecholamines and characteristically terminate with adenosine, vagal manoeuvres, and beta-blockers. The surface 12-lead electrocardiogram can be used to localize the anatomic site of origin before catheter ablation; however, prediction of the precise origin may still be challenging due to the intimate and complex anatomy of the outflow tracts.Case summaryA 12-year-old female presented to an emergency room with frequent runs of wide complex tachycardia that terminated with adenosine but would spontaneously reinitiate. After three additional temporary terminations with adenosine and because of an inability to completely eliminate tachycardia, she was started on an esmolol infusion that resulted in an abrupt termination of tachycardia. At follow-up, she reported breakthrough episodes of tachycardia with exercise, especially associated with beta-blocker non-compliance. The rest of her cardiac testing was normal apart from an anomalous right coronary artery origin from the left coronary sinus. Given the increased frequency of symptomatic palpitations and medication non-compliance, she underwent an electrophysiology study. During the study, a ventricular tachycardia was successfully mapped to an epicardial focus at the left ventricle summit and was successfully ablated.DiscussionThe response of this patient's ventricular tachycardia to adenosine suggests a triggered mechanism. To our knowledge, this is the first unambiguous example of left ventricular tachycardia due to cAMP-mediated triggered activity in this age group.
| S-EPMC10506732 | biostudies-literature
Project description:BackgroundVenous ethanol ablation (VEA) is effective for treatment of left ventricular (LV) summit (LVS) arrhythmias. The LVS venous anatomy is poorly understood and has inconsistent nomenclature.ObjectiveThe purpose of this study was to delineate the LVS venous anatomy by selective venography and 3-dimensional (3D) mapping during VEA and by venous-phase coronary computed tomographic angiography (vCTA).MethodsWe analyzed (1) LVS venograms and 3D maps of 53 patients undergoing VEA; and (2) 3D reconstructions of 52 vCTAs, tracing LVS veins.ResultsAngiography identified the following LVS veins: (1) LV annular branch of the great cardiac vein (GCV) (19/53); (2) septal (rightward) branches of the anterior ventricular vein (AIV) (53/53); and (3) diagonal branches of the AIV (51/53). Collateral connections between LVS veins and outflow, conus, and retroaortic veins were common. VEA was delivered to target arrhythmias in 38 of 53 septal, 6 of 53 annular, and 2 of 53 diagonal veins. vCTA identified LVS veins (range 1-5) in a similar distribution. GCV-AIV transition could either form an angle close to the left main artery bifurcation (n = 16; 88° ± 13°) or cut diagonally (n = 36; 133°±12°) (P ≤.001). Twenty-one patients had LV annular vein. In 28 patients only septal LVS veins were visualized in vCTA, in 2 patients only diagonal veins and in 22 patients both septal and diagonal veins were seen. In 39 patients the LVS veins reached the outflow tracts and their vicinity.ConclusionWe provide a systematic atlas and nomenclature of LVS veins related to arrhythmogenic substrates. vCTA can be useful for noninvasive evaluation of LVS veins before ethanol ablation.
| S-EPMC8419082 | biostudies-literature
Project description:Data on relative safety, efficacy, and role of different percutaneous left ventricular assist devices for hemodynamic support during the ventricular tachycardia (VT) ablation procedure are limited.We performed a multicenter, observational study from a prospective registry including all consecutive patients (N=66) undergoing VT ablation with a percutaneous left ventricular assist devices in 6 centers in the United States. Patients with intra-aortic balloon pump (IABP group; N=22) were compared with patients with either an Impella or a TandemHeart device (non-IABP group; N=44). There were no significant differences in the baseline characteristics between both the groups. In non-IABP group (1) more patients could undergo entrainment/activation mapping (82% versus 59%; P=0.046), (2) more number of unstable VTs could be mapped and ablated per patient (1.05±0.78 versus 0.32±0.48; P<0.001), (3) more number of VTs could be terminated by ablation (1.59±1.0 versus 0.91±0.81; P=0.007), and (4) fewer VTs were terminated with rescue shocks (1.9±2.2 versus 3.0±1.5; P=0.049) when compared with IABP group. Complications of the procedure trended to be more in the non-IABP group when compared with those in the IABP group (32% versus 14%; P=0.143). Intermediate term outcomes (mortality and VT recurrence) during 12±5-month follow-up were not different between both groups. Left ventricular ejection fraction ?15% was a strong and independent predictor of in-hospital mortality (53% versus 4%; P<0.001).Impella and TandemHeart use in VT ablation facilitates extensive activation mapping of several unstable VTs and requires fewer rescue shocks during the procedure when compared with using IABP.
| S-EPMC4329420 | biostudies-literature
Project description:BackgroundPremature ventricular contractions (PVCs) from left ventricular (LV) summit remain challenging for the risk of coronary artery injury. Computed tomographic or intracardiac echocardiography may be helpful, but both still have many limitations. CartoUNIVU module has rarely been used in PVC ablation.MethodsA total of 22 patients (14 men: mean age 56.4 ± 13.3 years) with an electrocardiogram indication of summit PVCs were included in the two centers study. A novel strategy ablation with the Image Integration Module CartoUNIVUTM module was performed for all the patients with PVCs originating from LV summit area, especially to prevent the coronary artery injury.ResultsThe procedure time was 78.6 ± 22.7 minutes, and the fluoroscopy time was 12.5 ± 3.1 minutes. The distance between the target and nearest coronary artery was 8.0 ± 3.1 mm. Three patients with the distance to the nearest coronary artery <5 mm. During a mean follow-up of 11.0 ± 1.7 months, 21/22 (95.5%) patients were free from clinical PVC. No coronary artery injury was detected in the all the ablation procedures.ConclusionThe novel strategy ablation with the Image Integration Module CartoUNIVU module is safe and effective for PVCs originating from LV summit area, especially to prevent the coronary artery injury.
| S-EPMC7462194 | biostudies-literature