Project description:BackgroundLeft ventricular hypertrophy (LVH) is an independent predictor of new-onset atrial fibrillation. Whether LVH can predict the recurrence of arrhythmia after radiofrequency catheter ablation (RFCA) in patients with paroxysmal atrial fibrillation (PAF) remains unclear.HypothesisPAF patients with baseline-electrocardiographic LVH has a higher recurrence rate after RFCA procedure compared with those without LVH.MethodsA total of 436 patients with PAF undergoing first RFCA were consecutively enrolled and clustered into 2 groups based on electrocardiogram (ECG) findings: non-ECG LVH (218 patients) and ECG LVH (218 patients). LVH was characterized by the Romhilt-Estes point score system; the score ≥5points were defined as LVH.ResultsAt 42 months' (interquartile range, 18.0-60.0 months) follow-up after RFCA, 151 (69.3%) patients in the non-ECG LVH group and 108 (49.5%) patients in the ECG LVH group maintained sinus rhythm without using antiarrhythmic drugs (P < 0.001). Patients with ECG LVH tended to experience a much higher prevalence of stroke and recurrence of atrial arrhythmia episodes compared with those without ECG LVH (log-rank P < 0.001). Multivariate analysis found the presence of ECG LVH and left atrial diameter to be independent risk factors for recurrence after adjusting for confounding factors.ConclusionsThe presence of ECG LVH was a strong and independent predictor of recurrence in patients with PAF following RFCA.
Project description:BackgroundCatheter ablation of ventricular tachycardia (VT) can be technically challenging due to difficulty with catheter positioning in the left ventricle (LV) and achieving stable contact. The Hansen Sensei Robotic system (HRS) has been used in atrial fibrillation but its utility in VT is unclear.ObjectiveThe purpose of this study was to test the technical feasibility of robotic catheter ablation of LV ventricular tachycardia (VT) using the HRS.MethodsTwenty-three patients underwent LV VT mapping and ablation with the HRS via a transseptal, transmitral valve approach. Nineteen patients underwent substrate mapping and ablation (18 had ischemic cardiomyopathy, 1 had an apical variant of hypertrophic cardiomyopathy). Four patients had focal VT requiring LV VT mapping and ablation. Procedural endpoints included substrate modification by endocardial scar border ablation and elimination of late potentials, or elimination of inducible focal VT.ResultsMapping and ablation were entirely robotic without requiring manual catheter manipulation in all patients and reaching all LV regions with stable contact. Fluoroscopy time of the LV procedure was 22.2 ± 11.2 minutes. Radiofrequency time was 33 ± 21 minutes. Total procedural times were 231 ± 76 minutes. Complications included a left groin hematoma (opposite to the HRS sheath), 1 pericardial effusion without tamponade that was drained successfully, and transient right ventricular failure in a patient with previous left ventricular assist device. At 13.4 ± 6.7 months of follow-up (range 1-19 months), recurrence of VT occurred in 3 of 23 patients.ConclusionOur initial experience suggests that the HRS allows successful mapping and ablation of LV VT.
Project description:The Revivent-TC(™)-system is able to restore LV volumes in patients with severe ischemic cardiomyopathy. We are presenting a case report of successful implantation of the Revivent-TC(™)-system, but postprocedural development of sustained VT. This case report is presenting one way to successfully treat patients with postprocedural frequent VT.
Project description:IntroductionVentricular perforation during radiofrequency ablation of ventricular tachycardia is a recognized serious complication that carries high morbidity and mortality. Perforation is often associated with local intramyocardial injury due to excess heat induced by catheter, 'steam pop'. The complication usually requires emergency surgical repair.Case presentationWe present a case, when the catheter found its way into the epicardium during left ventricular (LV) electroanatomic mapping without any serious complication. Angiography through the ablation catheter confirmed the diagnosis of LV coronary sinus fistula.DiscussionContrast injection through the irrigation port of the ablation catheter is a useful way of delineating anatomical anomalies during electrophysiology procedure.
Project description:Background: The mechanisms of atrial tachycardia (AT) related to the left atrial anterior wall (LAAW) are complex and can be challenging to map in patients after catheter ablation for atrial fibrillation (AF) or cardiac surgery. We aimed to investigate the electrophysiological characteristics AT and to devise an ablation strategy. Methods and Results: We identified 31 scar-related LAAW reentrant ATs in 22 patients after catheter ablation for AF or cardiac surgery. Activation maps of the left atrium (LA) or both atria were obtained using a high-density mapping system, and the precise mechanism and critical area for each AT were analyzed. Patients were followed up regularly in a clinic. After analyzing the activation and propagation of each AT, the scar-related LAAW ATs were classified into three types, based on mechanisms related to: (1) LAAW conduction gap(s) in 19 LA macro-reentrant ATs; (2) LAAW epicardial connection(s) in 11 LA or bi-atrial ATs; and (3) LAAW local micro-reentry in 1 LAAW AT. Multiple ATs were identified in seven patients. Effective ablation (termination or circuit change of AT) was obtained in 30 ATs by targeting the critical area identified by the mapping system. During 16.0 ± 7.6 months follow-up, recurrent AT occurred in two patients. Conclusions: Three mechanisms of scar-related AT of LAAW were identified, most of which were related to LAAW conduction gaps. Notably, epicardial AT or bi-atrial AT comprised a nonnegligible proportion. A high-density mapping system could make it possible to determine the accurate mechanism of AT and serve as a guide following ablation.
Project description:BackgroundCatheter ablation (CA) is efficacious for the treatment of ventricular tachycardia (VT) in patients with structural heart disease; however, heart failure contributes to long-term mortality in this cohort. Whether CA worsens left ventricular function requires investigation.MethodsWe retrospectively analyzed 142 consecutive patients with structural heart disease undergoing CA for VT. Pre-ablation left ventricular ejection fraction (LVEF) was compared to LVEF postablation, predictors of change in LVEF were identified, and the relationship between change in LVEF and arrhythmic recurrence was assessed.ResultsPatients with ischemic cardiomyopathy (ICM) had lower pre-ablation LVEF than patients with non-ischemic cardiomyopathy (NICM) (36.2 ± 14.3% vs. 50.8 ± 12.8%, p < 0.001). There was no statistically significant change in LVEF following ablation for patients with ICM (p = 0.45) or NICM (p = 0.75). Patients with pre-ablation LVEF ≤20% experienced the largest recovery in LVEF, mean recovery 5.3% (95% CI: 0.6-10.1), p = 0.03, with LVEF recovery postablation similar in ICM and NICM patients (p = 0.69). Recovery of LVEF was associated with a decreased incidence of ventricular arrhythmia (VA) recurrence (p = 0.03) and an increased VA-recurrence-free survival (p = 0.04).ConclusionCA for VT does not cause a decline in LVEF among patients with structural heart disease. The subset of patients with severely impaired LVEF may experience an increase in LVEF following ablation and an associated reduction in VA recurrence.