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Epicardial ablation

Anthony Li, Joseph Samuel Davis, Alexander Grimster, Jeremiah Wierwille, Keith Herold, Dennis Morgan, Elijah R Behr, Stephen Shorofsky, Magdi Saba
Aims: To determine if a software algorithm can use an individualized distance-morphology difference model, built from three initial pacemaps, to prospectively locate the exit site (ES) of ventricular arrhythmias (VA). Methods and results: Consecutive patients undergoing ablation of VA from a single centre were recruited. During mapping, three initial pacing points were collected in the chamber of interest and the navigation algorithm applied to predict the ES, which was corroborated by conventional mapping techniques...
March 8, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Cristiano F Pisani, Maria Antonieta Albanez de Medeiros Lopes, Hugo Bellotti, Liliane Kopel, Silvia G Lage, Mauricio I Scanavacca
No abstract text is available yet for this article.
March 7, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Grzegorz Suwalski, Robert Emery, Jakub Mróz, Kamil Kaczejko, Leszek Gryszko, Andrzej Cwetsch, Andrzej Skrobowski
OBJECTIVES: In patients undergoing cardiac surgical procedures, pulmonary vein isolation may be easily accomplished, and it is important to achieve bidirectional conduction block across created lesions. The primary aim of this study was to assess the risk of pulmonary vein stenosis (PVS) after multiple applications of epicardial bipolar radiofrequency energy. METHODS: Thirty-five consecutive patients who were referred for off-pump coronary revascularization with concomitant pulmonary vein isolation and left atrial appendage occlusion were prospectively included in the study...
March 7, 2018: Interactive Cardiovascular and Thoracic Surgery
Khola Tahir, Andy Kiser, Thomas Caranasos, J Paul Mounsey, Anil Gehi
WHO SHOULD UNDERGO HYBRID AF ABLATION?: Patients with symptomatic persistent or long-standing persistent atrial fibrillation refractory to pharmacological or routine catheter ablation can be considered for hybrid epicardial-endocardial AF ablation. Although it seems clear that patient selection should be important when considering hybrid AF ablation for optimal results, unfortunately, available data on the outcomes of hybrid epicardial-endocardial ablation is limited. Hybrid ablation is rarely compared to stand-alone catheter ablation, the surgical approach (access site, lesion set, ablation tool) is inconsistent, and the patient population studied is often suitable for a catheter ablation approach (paroxysmal AF, minimal structural heart disease)...
March 8, 2018: Current Treatment Options in Cardiovascular Medicine
Prabhpreet Singh, Amit Noheria
Invasive electrophysiology (EP) mapping and catheter ablation has increasingly become the standard of care for many cardiac arrhythmias like supraventricular tachycardias, atrial fibrillation, premature ventricular complexes (PVC), and monomorphic ventricular tachycardia. In this review, we discuss the recent progress made in the mapping and ablation of ventricular fibrillation (VF). Ventricular activation during VF is apparently disorganized, making mapping and interpretation difficult. Prolonged mapping during VF would require mechanical circulatory support as VF causes complete hemodynamic collapse...
March 6, 2018: Current Treatment Options in Cardiovascular Medicine
Shuanglun Xie, Benoit Desjardins, Maciej Kubala, Jackson Liang, Jiandu Yang, Rob J van der Geest, Robert Schaller, Michael Riley, David Callans, Erica Zado Pac, Francis Marchlinski, Saman Nazarian
BACKGROUND: Criteria for identification of anatomic ventricular tachycardia (VT) substrates in arrhythmogenic right ventricular cardiomyopathy (ARVC) on late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) are unclear. OBJECTIVE: We sought to define a) the association of regional RV epicardial voltage amplitude with the distribution of LGE, and b) appropriate image signal intensity (SI) thresholds for VT substrate identification, in ARVC. METHODS: Pre-procedural LGE-CMR and epicardial electrogram mapping were performed in 10 ARVC patients...
March 1, 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Mathew D Hutchinson, Hyon-He K Garza
As we have witnessed in other arenas of catheter-based therapeutics, ventricular tachycardia (VT) ablation has become increasingly anatomical in its execution. Multi-modality imaging provides anatomical detail in substrate characterization, which is often complex in nonischemic cardiomyopathy patients. Patients with intramural, intraseptal, and epicardial substrates provide challenges in delivering effective ablation to the critical arrhythmia substrate due to the depth of origin or the presence of adjacent critical structures...
February 24, 2018: Current Treatment Options in Cardiovascular Medicine
Laura R Bear, Peter R Huntjens, Richard Walton, Olivier Bernus, Ruben Coronel, Rémi Dubois
BACKGROUND: Poor identification of electrical dyssynchrony is postulated to be a major factor contributing to the low success rate for cardiac resynchronization therapy (CRT). OBJECTIVE: To evaluate body surface mapping and electrocardiographic imaging (ECGi) to detect electrical dyssynchrony noninvasively. METHODS: Langendorff-perfused pig hearts (n=11) were suspended in a human torso-shaped tank, with LBBB induced through ablation. Recordings were taken simultaneously from a 108-electrode epicardial sock and 128 electrodes embedded in the tank surface during sinus rhythm and ventricular pacing...
February 22, 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Christopher Piorkowski, Mads Kronborg, Jerome Hourdain, Judith Piorkowski, Bettina Kirstein, Sebastian Neudeck, Simon Wechselberger, Ellen Päßler, Anastasia Löwen, Ali El-Armouche, Julia Mayer, Stefan Ulbrich, Liying Pu, Utz Richter, Thomas Gaspar, Yan Huo
BACKGROUND: Until today, catheter interventional mapping and ablation of atrial fibrillation (AF) has been limited to the right and left atrial endocardium. We report feasibility, electrophysiological findings, and clinical outcome using a combined endo-/epicardial catheter approach for mapping and ablation of AF. METHODS AND RESULTS: Fifty-nine patients with permanence of pulmonary vein isolation and further symptomatic recurrences of paroxysmal AF, persistent AF, or atrial tachycardia underwent reablation using biatrial endo-/epicardial mapping and ablation...
February 2018: Circulation. Arrhythmia and Electrophysiology
Fei Lü, Wei Huang, David G Benditt
BACKGROUND: Current transcatheter ablation of ventricular tachycardia (VT) techniques is limited in part by its invasive nature and superficial depth of ablation lesions. OBJECTIVES: This study was aimed at evaluating the feasibility of targeted ablation of cardiac tissues using high-intensity focused ultrasound (HIFU) as a potential means for non-invasive ablation of VT. METHODS: Ablation of ventricular myocardium was performed in anesthetized closed-chest dogs using a HIFU therapeutic system that is currently used clinically for ablation of human solid tumors...
February 12, 2018: Journal of Cardiovascular Electrophysiology
David Soto-Iglesias, Juan Acosta, Diego Penela, Juan Fernández-Armenta, Mario Cabrera, Mikel Martínez, Francesca Vassanelli, Alejandro Alcaine, Markus Linhart, Beatriz Jáuregui, Elena Efimova, Rosario J Perea, Susana Prat-González, José T Ortiz-Pérez, Xavier Bosch, Luis Mont, Oscar Camara, Antonio Berruezo
BACKGROUND: Patients with transmural myocardial infarction (MI) who undergo endocardial-only substrate ablation are at an increased risk of ventricular tachycardia (VT) recurrence. Late gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) could be used to assess infarct transmurality (IT). However, the degree of IT associated to epicardial arrhythmogenic substrate (AS) has not been determined. OBJECTIVE: To determine the degree of IT observed in LGE-CMR and multi-detector computed tomography (MDCT) that predicts the presence of epicardial AS...
February 7, 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Jonathan Chrispin, Ali Keramati, Fabrizio R Assis, Satish Misra, Tarek Zghaib, Ronald D Berger, Hugh Calkins, Harikrishna Tandri
AIMS: Prior studies identified a relationship between epicardial bipolar and endocardial unipolar voltage. Whether the relationship is valid with smaller multielectrode mapping catheters has not been reported. We explored the association of right ventricular (RV) endocardial unipolar voltage mapping with epicardial bipolar voltage mapping using a multielectrode mapping catheter. METHODS: Electrograms from patients who underwent multielectrode endocardial and epicardial RV electroanatomical mapping during ablation procedures were analyzed...
February 6, 2018: Pacing and Clinical Electrophysiology: PACE
Chin-Yu Lin, Fa-Po Chung, Yenn-Jiang Lin, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Jo-Nan Liao, Ta-Chuan Tuan, Tze-Fan Chao, Yao-Ting Chang, Yun-Yu Chen, Abigail Louise D Te, Shinya Yamada, Shih-Ann Chen
Background: Epicardial catheter ablation has been shown to be an effective strategy for treating ventricular arrhythmias (VA). We investigated the efficacy and safety from a tertiary referral center in Taiwan. Methods: From 2010 to 2016, patients undergoing epicardial ablation for VAs were consecutively enrolled. The clinical characteristics, disease entity, electrophysiological studies, and ablation outcome were extracted for further analysis. Results: A total of 80 patients were eligible, including 34 patients for arrhythmogenic right ventricular cardiomyopathy (ARVC), 16 for Brugada syndrome (BrS), 13 for idiopathic VAs, 11 for idiopathic dilated cardiomyopathy (IDCM), 2 for ischemic cardiomyopathy, and 4 for other nonischemic cardiomyopathies (NICM)...
January 2018: Acta Cardiologica Sinica
Grzegorz Suwalski, Robert Emery, Jakub Mróz, Kamil Kaczejko, Leszek Gryszko, Andrzej Cwetsch, Andrzej Skrobowski
OBJECTIVES: In patients referred to off-pump coronary artery bypass grafting, pulmonary vein isolation (PVI) may be used for those with persistent atrial fibrillation (AF), an alternative to the Maze procedure. However, the success rate of PVI in persistent AF is limited. The study assesses the prognostic value of focal epicardial electrocardiography of the pulmonary veins (PVs) for surgical ablation results. METHODS: We mapped 140 PV in 35 cases undergoing off-pump coronary artery bypass grafting...
January 15, 2018: Interactive Cardiovascular and Thoracic Surgery
Jose M Sanchez, Ghannam Al-Dosari, Sherman Chu, Ramin Beygui, Tobias Deuse, Nitish Badhwar, Randall J Lee
Atrial fibrillation (AF) is the most common cardiac arrhythmia. The incidence of AF increases with age and is associated with increased stroke, heart failure and mortality. Persistent and long standing persistent AF is difficult to treat and often refractory to medical therapy and catheter ablation. Areas covered: This article reviews the historical development of the surgical Cox-MAZE procedure and current hybrid and minimally invasive surgical approaches for the treatment of persistent and long standing persistent AF...
February 2018: Expert Review of Cardiovascular Therapy
Charles M Pearman, Shi S Poon, Laura J Bonnett, Shouvik Haldar, Tom Wong, Neeraj Mediratta, Dhiraj Gupta
Maintaining sinus rhythm in patients with non-paroxysmal AF is an elusive goal. Some suggest that hybrid ablation, combining minimally invasive epicardial surgical ablation with endocardial catheter ablation, may be more effective than either modality alone. However, randomised trials are lacking. We investigated whether hybrid ablation is more effective than epicardial ablation alone at preventing recurrent AF by performing a systematic review and meta-analysis. The review was prospectively registered with PROSPERO (CRD42016043389)...
December 2017: Arrhythmia & Electrophysiology Review
Stavros Stavrakis, Sunny Po
Ganglionated plexi (GP), consisting of conglomerations of autonomic ganglia on the epicardial surface of the heart, have been shown to play a significant role in different arrhythmias, including atrial fibrillation. GP ablation has become an adjunctive procedure in the treatment of atrial fibrillation, while it has been used successfully in preliminary studies in vasovagal syncope. This review will present the current data on the physiology and clinical applications of GP ablation in the treatment of atrial fibrillation and other diseases...
December 2017: Arrhythmia & Electrophysiology Review
Michael Wolf, Milad El Haddad, Joël Fedida, Philippe Taghji, Katarina Van Beeumen, Teresa Strisciuglio, Jan De Pooter, Caroline Lepièce, Yves Vandekerckhove, René Tavernier, Mattias Duytschaever, Sébastien Knecht
Aims: Achieving block across linear lesions is challenging. We prospectively evaluated radiofrequency (RF) linear ablation at the roof and mitral isthmus (MI) using point-by-point contiguous and optimized RF lesions. Methods and results: Forty-one consecutive patients with symptomatic persistent AF underwent stepwise contact force (CF)-guided catheter ablation during ongoing AF. A single linear set of RF lesions was delivered at the roof and posterior MI according to the 'Atrial LINEar' (ALINE) criteria, i...
January 8, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Petra Maagh, Arnd Christoph, Henning Dopp, Markus Sebastian Mueller, Gunnar Plehn, Axel Meissner
Background: High-density mapping of ventricular tachycardia (VT) with PentaRay ® (Biosense-Webster) provides high resolution with discrimination of local abnormal electrograms and slow conducting channels. We evaluate the feasibility of PentaRay ® to characterize the anatomical substrate and assume an influence of the outcome despite limitations. Methods: Over a 24-month period, 26 endocardial and four epicardial maps were obtained of 26 VT patients (18 ischemic cardiomyopathy (ICM, 69...
December 2017: Cardiology Research
Lucas Hollanda Oliveira, Enia Coutinho, Marly Uellendahl, Guilherme Melo Ferreira, Fabrizio Raimundi, Cristiano Dietrich, Carlos Volponi, Christian Moreno Luize, Claudio Cirenza, Angelo de Paola
No abstract text is available yet for this article.
December 2017: HeartRhythm Case Reports
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