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VT and scar

Sachin Nayyar, Pawel Kuklik, Anand N Ganesan, Thomas R Sullivan, Lauren Wilson, Glenn D Young, Prashanthan Sanders, Kurt C Roberts-Thomson
BACKGROUND: In ventricular scar, impulse spread is slow because it traverses split and zigzag channels of surviving muscle. We aimed to evaluate scar electrograms to determine their local delay (activation time) and inequality in voltage splitting (entropy), and their relationship to channels. We reasoned that unlike innocuous channels, which are often short with multiple side branches, ventricular tachycardia (VT) supporting channels have very slow impulse spread and possess low entropy because of their longer protected length and relative lack of side-branching...
December 2016: Circulation. Arrhythmia and Electrophysiology
Yalçın Gökoğlan, Sanghamitra Mohanty, Carola Gianni, Pasquale Santangeli, Chintan Trivedi, Mahmut F Güneş, Rong Bai, Amin Al-Ahmad, G Joseph Gallinghouse, Rodney Horton, Patrick M Hranitzky, Javier E Sanchez, Salwa Beheiry, Richard Hongo, Dhanunjaya Lakkireddy, Madhu Reddy, Robert A Schweikert, Antonio Dello Russo, Michela Casella, Claudio Tondo, J David Burkhardt, Sakis Themistoclakis, Luigi Di Biase, Andrea Natale
BACKGROUND: Scar homogenization improves long-term ventricular arrhythmia-free survival compared with standard limited-substrate ablation in patients with post-infarction ventricular tachycardia (VT). Whether such benefit extends to patients with nonischemic cardiomyopathy and scar-related VT is unclear. OBJECTIVES: The aim of this study was to assess the long-term efficacy of an endoepicardial scar homogenization approach compared with standard ablation in this population...
November 1, 2016: Journal of the American College of Cardiology
Saurabh Kumar, Akira Fujii, Sunil Kapur, Jorge Romero, Nishaki K Mehta, Shinichi Tanigawa, Laurence M Epstein, Bruce A Koplan, Gregory F Michaud, Roy M John, William G Stevenson, Usha B Tedrow
AIMS: Catheter ablation can be lifesaving in ventricular tachycardia (VT) storm, but the underlying substrate in patients with storm is not well characterized. We sought to compare the clinical factors, substrate and outcomes differences in patients with sustained monomorphic VT who present for catheter ablation with VT storm versus those with a non-storm presentation. METHODS: Consecutive ischemic (ICM; n = 554) or non-ischemic cardiomyopathy patients (NICM; n = 369) with a storm vs...
October 26, 2016: Journal of Cardiovascular Electrophysiology
Walther H W Schulze, Zhong Chen, Jatin Relan, Danila Potyagaylo, Martin W Krueger, Rashed Karim, Manav Sohal, Anoop Shetty, YingLiang Ma, Nicholas Ayache, Maxime Sermesant, Herve Delingette, Julian Bostock, Reza Razavi, Kawal S Rhode, Christopher A Rinaldi, Olaf Dössel
ECG imaging is an emerging technology for the reconstruction of cardiac electric activity from non-invasively measured body surface potential maps. In this case report, we present the first evaluation of transmurally imaged activation times against endocardially reconstructed isochrones for a case of sustained monomorphic ventricular tachycardia (VT). Computer models of the thorax and whole heart were produced from MR images. A recently published approach was applied to facilitate electrode localization in the catheter laboratory, which allows for the acquisition of body surface potential maps while performing non-contact mapping for the reconstruction of local activation times...
September 20, 2016: Medical & Biological Engineering & Computing
Borislav Dinov, Kerstin Bode, Sebastian Koenig, Sabrina Oebel, Philipp Sommer, Andreas Bollmann, Gerhard Hindricks, Arash Arya
BACKGROUND: Inducibility of ventricular tachycardia (VT) has limited ability to predict recurrent VT after catheter ablation (CA). We sought to correlate the signal-averaged ECG (SAECG) with the endocardial scar characteristics in patients with ischemic VTs. We suggest that successful CA can result in normalization of the SAECG. METHODS AND RESULTS: Fifty patients (42 male; aged 67±10 years, ejection fraction 34±12%) with ischemic VTs were prospectively enrolled...
September 2016: Circulation. Arrhythmia and Electrophysiology
Saurabh Kumar, Samuel H Baldinger, Jorge Romero, Akira Fujii, Saagar N Mahida, Usha B Tedrow, William G Stevenson
INTRODUCTION: Substrate-based ablation for scar-related ventricular tachycardia (VT) has gained prominence: however, there is limited data comparing it to ablation guided predominantly by activation and entrainment mapping of inducible and hemodynamically tolerated VTs. We compared the acute procedural efficacy and outcomes of predominantly substrate-based ablation versus ablation guided predominantly by activation and entrainment mapping. METHODS AND RESULTS: Database searches through April 2016 identified 6 eligible studies (enrolling 403 patients, with 1 randomized study) comparing the 2 strategies...
October 6, 2016: Journal of Cardiovascular Electrophysiology
David S Frankel, Roderick Tung, Pasquale Santangeli, Wendy S Tzou, Marmar Vaseghi, Luigi Di Biase, Koichi Nagashima, Usha Tedrow, T Jared Bunch, Venkatakrishna N Tholakanahalli, Raghuveer Dendi, Madhu Reddy, Dhanunjaya Lakkireddy, Timm Dickfeld, J Peter Weiss, Nilesh Mathuria, Pasquale Vergara, Mehul Patel, Shiro Nakahara, Kairav Vakil, William H Sauer, David J Callans, Andrea Natale, William G Stevenson, Paolo Della Bella, Kalyanam Shivkumar, Francis E Marchlinski
Importance: Significant differences have been described between women and men regarding presentation, mechanism, and treatment outcome of certain arrhythmias. Previous studies of ventricular tachycardia (VT) ablation have not included sufficient women for meaningful comparison. Objective: To compare outcomes between women and men with structural heart disease undergoing VT ablation. Design, Setting, and Participants: Investigator-initiated, multicenter, observational study performed between 2002 and 2013, conducted by the International VT Ablation Center Collaborative Group, consisting of 12 high-volume ablation centers...
November 1, 2016: JAMA Cardiology
Saurabh Kumar, Alexander F A Androulakis, Jean-Marc Sellal, Philippe Maury, Estelle Gandjbakhch, Xavier Waintraub, Anne Rollin, Pascale Richard, Philippe Charron, Samuel H Baldinger, Ciorsti J Macintyre, Bruce A Koplan, Roy M John, Gregory F Michaud, Katja Zeppenfeld, Frederic Sacher, Neal K Lakdawala, William G Stevenson, Usha B Tedrow
BACKGROUND: Lamin A/C (LMNA) cardiomyopathy is a genetic disease with a proclivity for ventricular arrhythmias. We describe the multicenter experience with percutaneous catheter ablation of sustained monomorphic ventricular tachycardia (VT) in LMNA cardiomyopathy. METHODS AND RESULTS: Twenty-five consecutive LMNA mutation patients from 4 centers were included (mean age, 55±9 years; ejection fraction, 34±12%; VT storm in 36%). Complete atrioventricular block was present in 11 patients; 3 patients were on mechanical circulatory support for severe heart failure...
August 2016: Circulation. Arrhythmia and Electrophysiology
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
Seigo Yamashita, Hubert Cochet, Frédéric Sacher, Saagar Mahida, Benjamin Berte, Darren Hooks, Jean-Marc Sellal, Nora Al Jefairi, Antonio Frontera, Yuki Komatsu, Han S Lim, Sana Amraoui, Arnaud Denis, Nicolas Derval, Maxime Sermesant, François Laurent, Mélèze Hocini, Michel Haïssaguerre, Michel Montaudon, Pierre Jaïs
BACKGROUND: During the past years, many innovations have been introduced to facilitate catheter ablation of post-myocardial infarction ventricular tachycardia. However, the predictors of outcome after ablation were not thoroughly studied. METHODS AND RESULTS: From 2009 to 2013, consecutive patients referred for post-myocardial infarction ventricular tachycardia ablation were included. The end point of the procedure was complete elimination of local abnormal ventricular activities (LAVA) and ventricular tachycardia (VT) noninducibility...
July 2016: Circulation. Arrhythmia and Electrophysiology
Juan Acosta, Nuno Cabanelas, Diego Penela, Juan Fernández-Armenta, David Andreu, Roger Borràs, Viatcheslav Korshunov, Mario Cabrera, Francesca Vasanelli, Elena Arbelo, Eduard Guasch, Mikel Martínez, Jose M Tolosana, Lluis Mont, Antonio Berruezo
AIMS: This study assessed the benefit of peri-implantable cardioverter-defibrillator implant ventricular tachycardia (VT)-substrate ablation in patients with structural heart disease (SHD). METHODS AND RESULTS: Patients with SHD and indication for secondary prevention ICD implant were prospectively included. Patients presenting with incessant and/or slow VT or frequent (≥2) VT episodes who underwent peri-ICD VT-substrate ablation (the scar dechannelling technique) were compared with those who received ICD alone and did not meet ablation criteria...
June 27, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Christopher Reithmann, Bernhard Herkommer, Michael Fiek
BACKGROUND: Sustained ventricular tachycardia (VT) in patients with nonischemic cardiomyopathy (NICM) often involves midmyocardial and epicardial structures. Delayed-enhancement magnetic resonance imaging (DE-MRI) of scar and fibrosis is the method of choice to define the substrate of monomorphic VT. OBJECTIVE: The aim of the study was to compare the outcome of endocardial vs. epicardial VT ablation in patients with epicardial DE-MRI substrates in NICM. RESULTS: Among 44 patients with NICM referred for VT ablation who underwent DE-MRI, 12 patients had an epicardial-only (n = 4) or predominantly epicardial DE-MRI substrate (n = 8)...
October 2016: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Angelos G Rigopoulos, Silke Daci, Barbara Pfeiffer, Konstadia Papadopoulou, Anna Neugebauer, Hubert Seggewiss
INTRODUCTION: Percutaneous alcohol septal ablation (PTSMA) is an established treatment for symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). However, there is concern of a higher risk for ventricular tachyarrhythmias and sudden death due to the myocardial scar created after PTSMA. We investigated the possibility of increased ventricular arrhythmias and risk of sudden death after PTSMA in a subgroup of patients with an already implanted ICD. METHODS AND RESULTS: Between 2009 and 2012, 239 PTSMAs were performed in 212 patients with HOCM...
June 6, 2016: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
B P Betensky, F E Marchlinski
Sustained ventricular tachycardias are common in the setting of structural heart disease, either due to prior myocardial infarction or a variety of non-ischemic etiologies, including idiopathic dilated cardiomyopathy, hypertrophic cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy. Over the past two decades, percutaneous catheter ablation has evolved dramatically and has become an effective tool for the control of ventricular arrhythmias. Single and multicenter observational studies as well as several prospective randomized trials have begun to investigate long-term outcomes after catheter ablation procedures...
July 2016: Current Cardiology Reports
Kuo-Feng Chiang, Chien-Ming Cheng, Shih-Chuan Tsai, Wan-Yu Lin, Yu-Cheng Chang, Jin-Long Huang, Guang-Uei Hung, Chia-Hung Kao, Shih-Ann Chen, Pesus Chou, Ji Chen
BACKGROUND: Cardiac resynchronization therapy (CRT) can provide cardiac reverse remodeling (RR), which may include mechanical reverse remodeling (MRR) and/or electrical reverse remodeling (ERR). However, uncoupling of MRR and ERR is not uncommon, and the underlying mechanisms are not clear. This study aimed to evaluate the relationship of myocardial substrate characteristics as assessed by myocardial perfusion imaging (MPI) and cardiac RR post-CRT. MATERIALS AND METHODS: Forty-one patients (26 men, mean age 66 ± 10 years) with heart failure received CRT for at least 12 months were assigned to three groups according to their levels of RR: I, MRR + ERR (ESV reduced ≥15 % and intrinsic QRS duration reduced ≥10 ms); II, MRR only (ESV reduced ≥15 %); and III, non-responder (the others)...
August 2016: Annals of Nuclear Medicine
Junjie Zhang, Daniel H Cooper, Kavit A Desouza, Phillip S Cuculich, Pamela K Woodard, Timothy W Smith, Yoram Rudy
BACKGROUND: Ischemic cardiomyopathy (ICM) can provide the substrate for ventricular tachycardia (VT). OBJECTIVE: To map noninvasively with high resolution the electrophysiologic (EP) scar substrate, identify its relationship to reentry circuits during VT, and stratify VT risk in ICM patients. METHODS: Noninvasive high-resolution epicardial mapping with electrocardiographic imaging (ECGI) was performed in 32 ICM patients (17 with clinical VT, 15 without VT)...
August 2016: Pacing and Clinical Electrophysiology: PACE
Katja Zeppenfeld
Ventricular arrhythmias are an important cause of late morbidity and sudden cardiac death in the growing population of adults with repaired congenital heart disease. Risk stratification remains challenging because of the heterogeneity of the malformations and the surgical approaches. Therapeutic interventions depend on the type of ventricular arrhythmia, which can be polymorphic ventricular tachycardia (VT) or ventricular fibrillation in patients without ventricular scars, but also potentially fatal monomorphic reentrant VTs, typical for patients with ventricular scars or obstacles...
June 2016: Herzschrittmachertherapie & Elektrophysiologie
Juan Fernández-Armenta, Diego Penela, Juan Acosta, David Andreu, Reinder Evertz, Mario Cabrera, Viatcheslav Korshunov, Francesca Vassanelli, Mikel Martínez, Eduard Guasch, Elena Arbelo, Jose María Tolosana, Lluis Mont, Antonio Berruezo
BACKGROUND: The role and optimal sequence of ventricular tachycardia (VT) induction, mapping, and ablation when combined with substrate modification is unclear. OBJECTIVE: The purpose of this study was to test the benefits of starting the scar-related VT ablation procedure with substrate modification vs the standard protocol of VT induction, mapping, and ablation as the first step. METHODS: Forty-eight consecutive patients with structural heart disease and clinical VTs were randomized to simplified substrate ablation procedure with scar dechanneling as the first step (group 1, n = 24) or standard procedure with VT induction, mapping, and ablation followed by scar dechanneling (group 2, n = 24)...
August 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Ebru Golcuk, Kivanc Yalin, Tolga Aksu, Selma Kenar Tiryakioglu, Ahmet Kaya Bilge, Kamil Adalet
INTRODUCTION: The role of contrast-enhanced (ce) cardiac magnetic resonance in risk stratification of patients with depressed left ventricle (LV) function is widely studied. In this study, we investigated the myocardial infarct size and characteristics by ce-magnetic resonance imaging (MRI) and its relationship with spontaneous ventricular arrhythmia occurrence during follow-up of in patients with mild LV systolic dysfunction and nonsustained ventricular tachycardia (VT). MATERIALS AND METHODS: This study enrolled 32 patients with postmyocardial infarction with an LV ejection fraction between 40% and 50% and nonsustained VT...
May 2016: American Journal of the Medical Sciences
Juan J Pérez, Andre D'Avila, Arash Aryana, Macarena Trujillo, Enrique Berjano
INTRODUCTION: The outcomes of catheter ablation of scar-mediated ventricular tachycardia (VT) remain far from perfect. The presence of fat as a component of the underlying substrate for scar-mediated VT could be relevant since this entity can seriously impede the passage of RF current due to its low electrical conductivity. METHODS AND RESULTS: Computer models of RF ablation were built in order to investigate the means by which the spatial heterogeneity of different tissues represented within the ventricular infarct zone, including the viable myocardium, fibrous tissue, and fat, could influence temperature distributions during RF ablation...
August 2016: Journal of Cardiovascular Electrophysiology
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