Endocardial ablation to eliminate epicardial arrhythmia substrate in scar-related ventricular tachycardia.

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State: Public
Version: Final published version
Serval ID
serval:BIB_D7A34D512107
Type
Article: article from journal or magazin.
Collection
Publications
Title
Endocardial ablation to eliminate epicardial arrhythmia substrate in scar-related ventricular tachycardia.
Journal
Journal of the American College of Cardiology
Author(s)
Komatsu Y., Daly M., Sacher F., Cochet H., Denis A., Derval N., Jesel L., Zellerhoff S., Lim H.S., Jadidi A., Nault I., Shah A., Roten L., Pascale P., Scherr D., Aurillac-Lavignolle V., Hocini M., Haïssaguerre M., Jaïs P.
ISSN
1558-3597 (Electronic)
ISSN-L
0735-1097
Publication state
Published
Issued date
2014
Volume
63
Number
14
Pages
1416-1426
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
OBJECTIVES: We evaluated the feasibility and safety of epicardial substrate elimination with endocardial radiofrequency (RF) delivery in patients with scar-related ventricular tachycardia (VT).
BACKGROUND: Epicardial RF delivery is limited by fat or associated with bleeding, extra-cardiac damages, coronary vessels and phrenic nerve injury. Alternative ablation approaches might be desirable.
METHODS: Forty-six patients (18 ischemic cardiomyopathy [ICM], 13 nonischemic dilated cardiomyopathy [NICM], 15 arrhythmogenic right ventricular cardiomyopathy [ARVC]) with sustained VT underwent combined endo- and epicardial mapping. All patients received endocardial ablation targeting local abnormal ventricular activities in the endocardium (Endo-LAVA) and epicardium (Epi-LAVA), followed by epicardial ablation if needed.
RESULTS: From a total of 173 endocardial ablations targeting Epi-LAVA at the facing site, 48 (28%) applications (ICM: 20 of 71 [28%], NICM: 3 of 39 [8%], ARVC: 25 of 63 [40%]) successfully eliminated the Epi-LAVA. Presence of Endo-LAVA, the most delayed and low bipolar amplitude of Epi-LAVA, low unipolar amplitude in the facing endocardium, and Epi-LAVA within a wall thinning area at computed tomography scan were associated with successful ablation. Endocardial ablation could abolish all Epi-LAVA in 4 ICM and 2 ARVC patients, whereas all patients with NICM required epicardial ablation. Endocardial ablation was able to eliminate Epi-LAVA at least partially in 15 (83%) ICM, 2 (13%) NICM, and 11 (73%) ARVC patients, contributing to a potential reduction in epicardial RF applications. Pericardial bleeding occurred in 4 patients with epicardial ablation.
CONCLUSIONS: Elimination of Epi-LAVA with endocardial RF delivery is feasible and might be used first to reduce the risk of epicardial ablation.
Keywords
Adult, Aged, Cardiomyopathies/diagnosis, Cardiomyopathies/mortality, Catheter Ablation/methods, Catheter Ablation/mortality, Cicatrix/complications, Cicatrix/pathology, Cohort Studies, Electrocardiography/methods, Endocardium/surgery, Epicardial Mapping/methods, Feasibility Studies, Female, Follow-Up Studies, Humans, Male, Middle Aged, Postoperative Complications/mortality, Postoperative Complications/physiopathology, Retrospective Studies, Risk Assessment, Statistics, Nonparametric, Survival Rate, Tachycardia, Ventricular/diagnosis, Tachycardia, Ventricular/etiology, Treatment Outcome
Pubmed
Open Access
Yes
Create date
15/07/2014 12:10
Last modification date
20/08/2019 15:57
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