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Epicardial ablation

Massimiliano Faustino, Tullio Agricola, Borejda Xyheri, Enrico Di Girolamo, Luigi Leonzio, Carmine Pizzi
We report a patient with non-ischemic dilated cardiomyopathy and low left ventricular systolic function (28%) presenting with an electrical storm originated in epicardial scar and ablated by radiofrequency. This case report suggests that a strategy of epicardial catheter ablation is reasonable for the patient presenting with electrical storm related to structural disease with a low left ventricular ejection fraction.
September 2016: Indian Heart Journal
Joshua Xu, Jessica G Y Luc, Kevin Phan
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in modern clinical practice, with an estimated prevalence of 1.5-2%. The prevalence of AF is expected to double in the next decades, progressing with age and increasingly becoming a global medical challenge. The first-line treatment for AF is often medical treatment with either rate control or anti-arrhythmic agents for rhythm control, in addition to anti-coagulants such as warfarin for stroke prevention in patient at risk. Catheter ablation has emerged as an alternative for AF treatment, which involves myocardial tissue lesions to disrupt the underlying triggers and substrates for AF...
September 2016: Journal of Thoracic Disease
Antonio Berruezo, Juan Acosta, Juan Fernández-Armenta, Alonso Pedrote, Alberto Barrera, Eduardo Arana-Rueda, Andrés Ignacio Bodegas, Ignasi Anguera, Luis Tercedor, Diego Penela, David Andreu, Rosario Jesus Perea, Susana Prat-González, Lluis Mont
BACKGROUND: First-line endoepicardial ventricular tachycardia (VT) ablation has been proposed for patients with arrhythmogenic cardiomyopathy (AC). This study reports procedural safety, outcomes, and predictors of recurrence. METHODS AND RESULTS: Forty-one consecutive patients [12 with left ventricle (LV) involvement, 7 left-dominant] underwent first-line endoepicardial VT substrate ablation. Standard bipolar and unipolar thresholds were used to define low-voltage areas (LVA)...
October 12, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Guo Jincun, Zhou Faguang, Huang Weibin, Wang Yan, Dong Kang, Roderick Tung
No abstract text is available yet for this article.
October 2016: Circulation. Arrhythmia and Electrophysiology
Daniele Muser, Pasquale Santangeli, Simon A Castro, Rajeev K Pathak, Jackson J Liang, Tatsuya Hayashi, Silvia Magnani, Fermin C Garcia, Mathew D Hutchinson, Gregory G Supple, David S Frankel, Michael P Riley, David Lin, Robert D Schaller, Sanjay Dixit, Erica S Zado, David J Callans, Francis E Marchlinski
BACKGROUND: Catheter ablation (CA) of ventricular tachycardia (VT) in patients with nonischemic dilated cardiomyopathy can be challenging because of the complexity of underlying substrates. We sought to determine the long-term outcomes of endocardial and adjuvant epicardial CA in nonischemic dilated cardiomyopathy. METHODS AND RESULTS: We examined 282 consecutive patients (aged 59±15 years, 80% males) with nonischemic dilated cardiomyopathy who underwent CA. Ablation was guided by activation/entrainment mapping for tolerated VT and pacemapping/targeting of abnormal electrograms for unmappable VT...
October 2016: Circulation. Arrhythmia and Electrophysiology
Takumi Yamada, Harish Doppalapudi, Silvio H Litovsky, H Thomas McElderry, G Neal Kay
BACKGROUND: Radiofrequency catheter ablation (RFCA) of idiopathic ventricular arrhythmias (VAs) originating from the basal portion of the left ventricular (LV) summit, which is divided from the apical LV (A-LV) summit by the great cardiac vein (GCV), is challenging. This study investigated the efficacy of RFCA and electrocardiographic and electrophysiological characteristics of these VAs. METHODS AND RESULTS: Forty-five consecutive patients with symptomatic idiopathic LV summit VAs were studied...
October 2016: Circulation. Arrhythmia and Electrophysiology
Charles Kik, Richard van Valen, Mostafa M Mokhles, Jos A Bekkers, Ad J J C Bogers
Minimally invasive video-assisted epicardial beating heart ablation for lone atrial fibrillation claims to be safe and effective. We, however, report on three patients with an atrioesophageal fistula after this procedure. The exact pathogenesis of this complication is unknown. All patients presented around 6 weeks after surgery with either fever or neurological deficits. Diagnosis can be made by computed tomography scan. We advocate an aggressive surgical approach with closure of the atrial defect on cardiopulmonary bypass and closure and reinforcement of the esophagus with an intercostal muscle flap in a single-stage surgery...
September 29, 2016: Thoracic and Cardiovascular Surgeon
Prabhat Kumar, Ayotunde M Bamimore, Jennifer D Schwartz, Eugene H Chung, Anil K Gehi, Andy C Kiser, James P Hummel, J Paul Mounsey
BACKGROUND: The left atrial posterior wall (PW) often contains sites required for maintenance of atrial fibrillation (AF). Electrical isolation of the PW is an important feature of all open surgeries for AF. This study assessed the ability of current ablation techniques to achieve PW isolation (PWI) and its effect on recurrent AF. METHODS AND RESULTS: Fifty-seven consecutive patients with persistent or high-burden paroxysmal AF underwent catheter ablation, which was performed using an endocardial-only (30) or a hybrid endocardial-epicardial procedure (27)...
2016: Journal of the American Heart Association
Sandeep A Saha, Kousik Krishnan, Christopher Madias, Richard G Trohman
A 34-year-old man with Brugada syndrome (BrS) presented with electrical storm, manifested as multiple appropriate shocks from his implantable cardioverter-defibrillator over a period of 7 hours. He had not tolerated prior treatment with quinidine, and had self-discontinued cilostazol citing persistent palpitations. After stabilization with intravenous isoproterenol, an electrophysiology study was performed but no spontaneous or induced ventricular ectopic beats were identified. A three-dimensional (3D) endocardial electro-anatomic map of the right ventricular outflow tract (RVOT), pulmonic valve, and pulmonary artery, as well as a 3D epicardial map of the RVOT, were created...
September 19, 2016: Cardiology and Therapy
Takumi Yamada, Harish Doppalapudi, William R Maddox, H Thomas McElderry, Vance J Plumb, G Neal Kay
BACKGROUNDS: Idiopathic ventricular arrhythmias (VAs) originating from the left ventricular outflow tract (LVOT) sometimes require catheter ablation from both the endocardial and epicardial sides for their elimination, suggesting the presence of intramural VA foci. This study investigated the prevalence and electrocardiographic and electrophysiological characteristics of these idiopathic intramural LVOT VAs when compared with the idiopathic endocardial and epicardial LVOT VAs. METHODS AND RESULTS: We studied 82 consecutive VAs with origins in the aortomitral continuity (n=30), LV summit (n=34), and intramural site (n=18)...
September 2016: Circulation. Arrhythmia and Electrophysiology
Deniz Akdis, Corinna Brunckhorst, Firat Duru, Ardan M Saguner
This overview gives an update on the molecular mechanisms, clinical manifestations, diagnosis and therapy of arrhythmogenic cardiomyopathy (ACM). ACM is mostly hereditary and associated with mutations in genes encoding proteins of the intercalated disc. Three subtypes have been proposed: the classical right-dominant subtype generally referred to as ARVC/D, biventricular forms with early biventricular involvement and left-dominant subtypes with predominant LV involvement. Typical symptoms include palpitations, arrhythmic (pre)syncope and sudden cardiac arrest due to ventricular arrhythmias, which typically occur in athletes...
August 2016: Arrhythmia & Electrophysiology Review
Zaid Aziz, Joshua D Moss, Mehran Jabbarzadeh, Jeffery Hellstrom, Husam Balkhy, Roderick Tung
No abstract text is available yet for this article.
September 7, 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Antoine H G Driessen, Wouter R Berger, Sébastien P J Krul, Nicoline W E van den Berg, Jolien Neefs, Femke R Piersma, Dean R P P Chan Pin Yin, Jonas S S G de Jong, WimJan P van Boven, Joris R de Groot
BACKGROUND: Patients with long duration of atrial fibrillation (AF), enlarged atria, or failed catheter ablation have advanced AF and may require more extensive treatment than pulmonary vein isolation. OBJECTIVES: The aim of this study was to investigate the efficacy and safety of additional ganglion plexus (GP) ablation in patients undergoing thoracoscopic AF surgery. METHODS: Patients with paroxysmal AF underwent pulmonary vein isolation...
September 13, 2016: Journal of the American College of Cardiology
Ammar M Killu, Siva K Mulpuru, Mohammed A Al-Hijji, Alan Sugrue, Thomas M Munger, David O Hodge, Christopher J McLeod, Douglas L Packer, Suraj Kapa, Samuel J Asirvatham, Paul A Friedman
Percutaneous epicardial access (EpiAcc) is used in an attempt to improve outcomes of ablation. We aim to report our experience in EpiAcc for management of symptomatic ventricular premature complexes (VPC) and ventricular tachycardia (VT). All patients from January 2004 to July 2014 who underwent EpiAcc as part of a VPC or VT ablation procedure were included. Outcomes between those with endocardial-only (Gp1) and endocardial/epicardial (Gp2) ablation and those for VPC and VT ablation were compared. EpiAcc for VPC or VT ablation was attempted in 173 patients; 10 patients were excluded because of failure of access (n = 7) or no ablation performed (n = 3)...
September 15, 2016: American Journal of Cardiology
Tarek Zghaib, Esra Gucuk Ipek, Sohail Zahid, Muhammad Adnan Balouch, Satish Misra, Hiroshi Ashikaga, Ronald D Berger, Joseph E Marine, David D Spragg, Stefan L Zimmerman, Vadim Zipunnikov, Natalia Trayanova, Hugh Calkins, Saman Nazarian
BACKGROUND: Epicardial adipose tissue (EAdT) is metabolically active and likely contributes to atrial fibrillation (AF) through the release of inflammatory cytokines into the myocardium or through its rich innervation with ganglionated plexi at the pulmonary vein ostia. The electrophysiologic mechanisms underlying the association between EAdT and AF remain unclear. OBJECTIVE: The purpose of this study was to investigate the association of EAdT with adjacent myocardial substrate...
August 19, 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Jinzhu Hu, Shan Zeng, Qiongqiong Zhou, Wengen Zhu, Zhenyan Xu, Jianhua Yu, Kui Hong
BACKGROUND: At present, the role of ventricular tachycardia (VT) non-inducibility after ablation in patients with non-ischemic cardiomyopathy (NICM) remains controversial. We conducted a meta-analysis of the published literature to assess whether VT non-inducibility after ablation could predict reduced VT recurrence and mortality in patients with NICM. METHODS: PubMed, ScienceDirect, and the Cochrane library were searched for studies evaluating the effects of VT non-inducibility after catheter ablation on the long-term outcome in NICM patients with sustained VT...
November 1, 2016: International Journal of Cardiology
Suvash Shrestha, On Chen, Mary Greene, Jinu Jacob John, Yisachar Greenberg, Felix Yang
Convergent atrial fibrillation ablation involves extensive epicardial as well as endocardial ablation of the left atrium. We examined whether it changes the morphology of the surface P wave. We reviewed electrocardiograms of 29 patients who underwent convergent ablation for atrial fibrillation. In leads V1, II and III, we measured P wave duration, area and amplitude before ablation, and at 1, 3 and 6 months from ablation. After ablation, there were no significant changes in P wave amplitude, area, or duration in leads II and III...
January 2016: Indian Pacing and Electrophysiology Journal
Daljeet Kaur Saggu, Sandeep G Nair, Abhijeet Shelke, Sachin Yalagudri, Calambur Narasimhan
A 55 year old male presented with recurrent implantable cardioverter defibrillator (ICD) shocks due to polymorphic ventricular tachycardia (PMVT). He had undergone prior catheter ablation for VT three years ago. During the prior attempt he underwent voltage guided substrate ablation. With programmed ventricular extrastimulation (PVES), PMVT was repeatedly induced requiring DC shock. Intravenous procainamide was administered and PVES was repeated which induced sustained monomorphic ventricular tachycardia (MMVT)...
November 2015: Indian Pacing and Electrophysiology Journal
V Sawhney, A Breitenstein, W Ullah, M Finlay, S Sporton, M J Earley, A W Chow, M Dhinoja, P Lambiase, R J Schilling, R J Hunter
BACKGROUND: Current guidelines for epicardial catheter ablation for ventricular tachycardia (VT) advocate that epicardial access is avoided in anticoagulated patients and should be performed prior to heparinisation. Recent studies have shown that epicardial access may be safe in heparinised patients. However, no data exist for patients on oral anticoagulants. We investigated the safety of obtaining epicardial access on uninterrupted warfarin. METHODS: A prospective registry of patients undergoing epicardial VT ablation over two years was analysed...
November 1, 2016: International Journal of Cardiology
Pei Zhang, Roderick Tung, Zuwen Zhang, Xia Sheng, Qiang Liu, Ruhong Jiang, Yaxun Sun, Shiquan Chen, Lu Yu, Yang Ye, Guosheng Fu, Kalyanam Shivkumar, Chenyang Jiang
BACKGROUND: Catheter ablation in the right ventricular outflow tract (RVOT) may modify the electrophysiologic substrate for recurrent ventricular tachycardia/ventricular fibrillation (VT/VF) in patients with Brugada syndrome (BrS). OBJECTIVE: The purpose of this study was to investigate the mechanism and arrhythmogenic substrate of VT/VF and to evaluate the long-term outcomes of catheter ablation in patients with BrS. METHODS: Eleven consecutive patients with BrS referred to 2 academic medical centers underwent combined epicardial-endocardial electroanatomic mapping...
July 22, 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
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