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Cardiac Electrophysiology Clinics

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https://www.readbyqxmd.com/read/28167092/ventricular-tachycardia-in-structural-heart-disease
#1
EDITORIAL
Amin Al-Ahmad, Francis E Marchlinski
No abstract text is available yet for this article.
March 2017: Cardiac Electrophysiology Clinics
https://www.readbyqxmd.com/read/28167091/ventricular-tachycardia-ablation
#2
EDITORIAL
Ranjan K Thakur, Andrea Natale
No abstract text is available yet for this article.
March 2017: Cardiac Electrophysiology Clinics
https://www.readbyqxmd.com/read/28167090/ablation-of-ventricular-tachycardia-in-arrhythmogenic-right-ventricular-dysplasia
#3
REVIEW
Rajeev K Pathak, Fermin C Garcia
Endocardial and epicardial electroanatomical mapping and ablation is a safe and effective therapy in the treatment of right ventricle arrhythmias occurring in the setting of arrhythmogenic right ventricular cardiomyopathy (ARVD). Careful mapping and ablation plans must be tailored for each patient based on comorbidities and ventricular tachycardia morphologies. This review focuses on the catheter ablation for ventricular arrhythmias in patients with ARVD.
March 2017: Cardiac Electrophysiology Clinics
https://www.readbyqxmd.com/read/28167089/alternative-approaches-for-ablation-of-resistant-ventricular-tachycardia
#4
REVIEW
Carola Gianni, Sanghamitra Mohanty, Chintan Trivedi, Luigi Di Biase, Amin Al-Ahmad, Andrea Natale, J David Burkhardt
Ventricular tachycardia (VT) ablation is usually performed with an ablation catheter that delivers unipolar radiofrequency (RF) energy to eliminate the re-entry circuit responsible for VT. However, there are some instances when unipolar RF ablation fails, notably in VTs with a deep intramural origin, or cases in which epicardial access is not attainable due to prior cardiac surgery. To overcome these limitations, several alternative approaches have been used in clinical practice, including alcohol ablation or coil embolization, simultaneous unipolar or bipolar RF ablation, surgical ablation, or noninvasive ablation with stereotactic radiosurgery...
March 2017: Cardiac Electrophysiology Clinics
https://www.readbyqxmd.com/read/28167088/substrate-ablation-of-ventricular-tachycardia-late-potentials-scar-dechanneling-local-abnormal-ventricular-activities-core-isolation-and-homogenization
#5
REVIEW
David F Briceño, Jorge Romero, Carola Gianni, Sanghamitra Mohanty, Pedro A Villablanca, Andrea Natale, Luigi Di Biase
Ventricular arrhythmias are a frequent cause of mortality in patients with ischemic cardiomyopathy and nonischemic cardiomyopathy. Scar-related reentry represents the most common arrhythmia substrate in patients with recurrent episodes of sustained ventricular tachycardia (VT). Initial mapping of scar-related VT circuits is focused on identifying arrhythmogenic tissue. The substrate-based strategies include targeting late potentials, scar dechanneling, local abnormal ventricular activities, core isolation, and homogenization of the scar...
March 2017: Cardiac Electrophysiology Clinics
https://www.readbyqxmd.com/read/28167087/pace-mapping-to-localize-the-critical-isthmus-of-ventricular-tachycardia
#6
REVIEW
Christian de Chillou, Jean-Marc Sellal, Isabelle Magnin-Poull
Most postinfarct ventricular tachycardias (VT) are sustained by a reentrant mechanism. The "protected isthmus" of the reentrant circuit is critical for the maintenance of VTs and the target for catheter ablation. In this article, the authors describe the technique of pace-mapping during sinus rhythm to unmask postinfarct VT isthmuses. A pace-mapping map should be considered as the surrogate of an activation map during VT, in both patients with a normal heart and patients with a structural heart disease. Pace mapping is useful to unmask VT isthmuses in patients with postinfarct reentrant VTs...
March 2017: Cardiac Electrophysiology Clinics
https://www.readbyqxmd.com/read/28167086/entrainment-mapping
#7
REVIEW
Saurabh Kumar, Usha B Tedrow, William G Stevenson
Mapping during ventricular tachycardia (VT) aims to elucidate mechanism, describe myocardial propagation, and identify the origin and critical regions of VT that can be targeted for ablation, most commonly with radiofrequency ablation. Most VTs in structural heart disease are due to macro-reentry in and around scar. A combination of mapping techniques, including mapping to identify the arrhythmia substrate, activation sequence mapping, pace-mapping, and entrainment mapping, may be used to identify putative ablation targets...
March 2017: Cardiac Electrophysiology Clinics
https://www.readbyqxmd.com/read/28167085/catheter-ablation-for-ventricular-tachycardia-in-patients-with-nonischemic-cardiomyopathy
#8
REVIEW
Nathaniel Thompson, Antonio Frontera, Masateru Takigawa, Ghassen Cheniti, Gregoire Massoullie, Hubert Cochet, Arnaud Denis, Arnaud Chaumeil, Nicolas Derval, Meleze Hocini, Michel Haissaguerre, Pierre Jais, Frederic Sacher
Although catheter ablation has been successful in reducing the recurrence of ventricular tachycardia in patients with ischemic disease, outcomes in patients with nonischemic cardiomyopathy (NICM) have not met with the same results. Success is predicated on a methodical approach to diagnosis of disease type and identification of critical substrate, and the ablation strategies used. Cardiac MRI with delayed enhancement is able to identify areas of substrate involvement, particularly in situations when conventional catheter mapping is not able to do so...
March 2017: Cardiac Electrophysiology Clinics
https://www.readbyqxmd.com/read/28167084/ventricular-tachycardia-in-ischemic-heart-disease
#9
REVIEW
Ronald Lo, Karin K M Chia, Henry H Hsia
Ventricular arrhythmias are a significant cause of morbidity and mortality in patients with ischemic structural heart disease. Endocardial and epicardial mapping strategies include scar characterization channel identification, and recording and ablation of late potentials and local abnormal ventricular activities. Catheter ablation along with new technology and techniques of bipolar ablation, needle catheter, and autonomic modulation may increase efficacy in difficult to ablate ventricular arrhythmias. Catheter ablation of ventricular arrhythmias seem to confer mortality and morbidity benefits in patients with ischemic heart disease...
March 2017: Cardiac Electrophysiology Clinics
https://www.readbyqxmd.com/read/28167083/ventricular-tachycardia-ablation-clinical-trials
#10
REVIEW
Jackson J Liang, Daniele Muser, Pasquale Santangeli
Catheter ablation is an increasingly used treatment option for patients with ventricular tachycardia (VT) in the setting of structural heart disease. Although there are extensive data from several retrospective studies as well as prospective nonrandomized observational studies, there are limited data from relatively few randomized controlled trials, especially comparing VT ablation with antiarrhythmic drugs. In this review, the authors aim to summarize the major studies examining efficacy of VT ablation in patients with structural heart disease, discuss barriers to enrollment and completion of randomized clinical trials, and propose areas of future research in the field...
March 2017: Cardiac Electrophysiology Clinics
https://www.readbyqxmd.com/read/28167082/hemodynamic-support-for-ventricular-tachycardia-ablation
#11
REVIEW
Chandrasekar Palaniswamy, Marc A Miller, Vivek Y Reddy, Srinivas R Dukkipati
This review discusses the role of hemodynamic support for catheter ablation of unstable ventricular tachycardia, using commercially available mechanical circulatory support devices (intra-aortic balloon pump, Impella, TandemHeart, extracorporeal membrane oxygenation) and analyzes the published clinical experience of the safety and efficacy of these devices during ventricular tachycardia ablation. Appropriate selection of patients, device-specific characteristics, and hemodynamic monitoring is also discussed...
March 2017: Cardiac Electrophysiology Clinics
https://www.readbyqxmd.com/read/28167081/premature-ventricular-complex-ablation-in-structural-heart-disease
#12
REVIEW
Rakesh Latchamsetty, Frank Bogun
Frequent premature ventricular complexes (PVCs) in patients with underlying structural heart disease, particular after myocardial infarction, can predict increased mortality. Use of antiarrhythmic medications to suppress PVCs in this setting can result in a further increase in mortality. High PVC burdens in patients with structural heart disease can cause or worsen cardiomyopathy and successful elimination of PVCs with catheter ablation can improve or, in some cases normalize, cardiac function. PVCs may also trigger more malignant ventricular arrhythmias, particularly in patients with previous myocardial infarction, and when identified can be mapped and ablated...
March 2017: Cardiac Electrophysiology Clinics
https://www.readbyqxmd.com/read/28167080/epicardial-catheter-ablation-of-ventricular-tachycardia
#13
REVIEW
Arash Aryana, André d'Avila
Over the last two decades, epicardial catheter ablation has evolved into a practical approach for treatment of ventricular tachycardia (VT). There are certain considerations when performing this procedure. First, presence of epicardial fat can diminish peak-to-peak electrogram amplitude and also impede radiofrequency energy delivery. Hence, epicardial VT ablation should be performed with cooled-tip radiofrequency using reduced irrigation flow within a relatively 'dry' pericardial milieu. Furthermore, catheter orientation is key when performing epicardial ablation...
March 2017: Cardiac Electrophysiology Clinics
https://www.readbyqxmd.com/read/28167079/anatomy-for-ventricular-tachycardia-ablation-in-structural-heart-disease
#14
REVIEW
Jason S Bradfield, Kalyanam Shivkumar
Ablation of ventricular tachycardia (VT) in the setting of structural heart disease, previously reserved for highly experienced specialized centers, is being performed at more centers internationally as cardiac electrophysiologists gain advanced training. Interventional cardiac electrophysiologists need a high level of anatomic knowledge to guide a procedure that can carry significant risk. Understanding cardiac anatomy improves the chance of procedural success and also the likelihood of appropriate decision making if complications are encountered...
March 2017: Cardiac Electrophysiology Clinics
https://www.readbyqxmd.com/read/28167078/ablation-of-ventricular-tachycardia-in-congenital-and-infiltrative-heart-disease
#15
REVIEW
Adrianus P Wijnmaalen, Katja Zeppenfeld
Radiofrequency catheter ablation (RFCA) is an important treatment modality to prevent ventricular tachycardia (VT) recurrence in patients with repaired congenital heart disease. Identification and ablation of anatomic isthmuses has improved acute ablation outcome with excellent VT-free survival in those with preserved biventricular function. Reports on RFCA for VT in patients with infiltrative disease are sparse and cardiac sarcoidosis seems to be the most prevalent cause for ventricular arrhythmia. Patients with active and ongoing inflammation are at high risk for VT recurrence...
March 2017: Cardiac Electrophysiology Clinics
https://www.readbyqxmd.com/read/28167077/electrocardiographic-localization-of-ventricular-tachycardia-in-patients-with-structural-heart-disease
#16
REVIEW
John M Miller, Rahul Jain, Gopi Dandamudi, Thomas R Kambur
The 12-lead electrocardiogram (ECG) during ventricular tachycardia (VT) in patients with structural heart disease contains information that helps to narrow the electrophysiologist's search for target sites for ablation. Although replacement of myocardium by scar might be expected to produce variability in the spread of activation during VT, nonetheless reasonably consistent ECG patterns exist that can regionalize exit sites from VT circuits in up to 75% of cases. Most experience with this comes from patients with prior myocardial infarction, but a growing body of data exists concerning patients with nonischemic cardiomyopathies...
March 2017: Cardiac Electrophysiology Clinics
https://www.readbyqxmd.com/read/27837902/pathophysiology-of-the-human-his-purkinje-system
#17
EDITORIAL
Masood Akhtar
No abstract text is available yet for this article.
December 2016: Cardiac Electrophysiology Clinics
https://www.readbyqxmd.com/read/27837901/foreword
#18
EDITORIAL
Ranjan K Thakur, Andrea Natale
No abstract text is available yet for this article.
December 2016: Cardiac Electrophysiology Clinics
https://www.readbyqxmd.com/read/27837900/changes-in-the-reentrant-pathway-in-verapamil-sensitive-fascicular-reentrant-ventricular-tachycardia-during-ablation
#19
REVIEW
Patrick Tchou, Khaldoun Tarakji, Mohamed Kanj
The sequence of changes in the QRS morphology and the accompanying cycle lengths of the tachycardia confirm that the reentrant circuit involves the left ventricular myocardium as well as the His Purkinje system as part of the reentrant circuit. The reentrant propagation likely goes from local left ventricular myocardium into a slowly conducting, verapamil-sensitive tissue, which then connects into the inferior fascicle. This case demonstrates that fascicular reentrant tachycardias can generate different QRS morphologies depending on the path of breakout into the myocardium...
December 2016: Cardiac Electrophysiology Clinics
https://www.readbyqxmd.com/read/27837899/retrograde-concealed-conduction-in-the-his-purkinje-system
#20
REVIEW
Masood Akhtar
An 83-year-old man was seen due to recurrent syncopal episodes. Only the His bundle recording was able to be obtained, which showed the His-Purkinje System as the site of a conduction delay. A permanent dual-chamber pacemaker was implanted with no further syncopal episodes.
December 2016: Cardiac Electrophysiology Clinics
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