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Selected Publication:
SHR Neuro Cancer Cardio Lipid Metab Microb
Komatsu, Y; Daly, M; Sacher, F; Cochet, H; Denis, A; Derval, N; Jesel, L; Zellerhoff, S; Lim, HS; Jadidi, A; Nault, I; Shah, A; Roten, L; Pascale, P; Scherr, D; Aurillac-Lavignolle, V; Hocini, M; Haïssaguerre, M; Jaïs, P.
Endocardial ablation to eliminate epicardial arrhythmia substrate in scar-related ventricular tachycardia.
J Am Coll Cardiol. 2014; 63(14):1416-1426
Doi: 10.1016/j.jacc.2013.10.087
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- Co-authors Med Uni Graz
- Scherr Daniel
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- Abstract:
- We evaluated the feasibility and safety of epicardial substrate elimination with endocardial radiofrequency (RF) delivery in patients with scar-related ventricular tachycardia (VT). Epicardial RF delivery is limited by fat or associated with bleeding, extra-cardiac damages, coronary vessels and phrenic nerve injury. Alternative ablation approaches might be desirable. Forty-six patients (18 ischemic cardiomyopathy [ICM], 13 nonischemic dilated cardiomyopathy [NICM], 15 arrhythmogenic right ventricular cardiomyopathy [ARVC]) with sustained VT underwent combined endo- and epicardial mapping. All patients received endocardial ablation targeting local abnormal ventricular activities in the endocardium (Endo-LAVA) and epicardium (Epi-LAVA), followed by epicardial ablation if needed. From a total of 173 endocardial ablations targeting Epi-LAVA at the facing site, 48 (28%) applications (ICM: 20 of 71 [28%], NICM: 3 of 39 [8%], ARVC: 25 of 63 [40%]) successfully eliminated the Epi-LAVA. Presence of Endo-LAVA, the most delayed and low bipolar amplitude of Epi-LAVA, low unipolar amplitude in the facing endocardium, and Epi-LAVA within a wall thinning area at computed tomography scan were associated with successful ablation. Endocardial ablation could abolish all Epi-LAVA in 4 ICM and 2 ARVC patients, whereas all patients with NICM required epicardial ablation. Endocardial ablation was able to eliminate Epi-LAVA at least partially in 15 (83%) ICM, 2 (13%) NICM, and 11 (73%) ARVC patients, contributing to a potential reduction in epicardial RF applications. Pericardial bleeding occurred in 4 patients with epicardial ablation. Elimination of Epi-LAVA with endocardial RF delivery is feasible and might be used first to reduce the risk of epicardial ablation. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
- Find related publications in this database (using NLM MeSH Indexing)
- Adult -
- Aged -
- Cardiomyopathies - diagnosis
- Cardiomyopathies - mortality
- Cardiomyopathies - surgery
- Catheter Ablation - methods
- Catheter Ablation - mortality
- Cicatrix - complications
- Cicatrix - pathology
- Cohort Studies -
- Electrocardiography - methods
- Endocardium - surgery
- Epicardial Mapping - methods
- Feasibility Studies -
- Female -
- Follow-Up Studies -
- Humans -
- Male -
- Middle Aged -
- Postoperative Complications - mortality
- Postoperative Complications - physiopathology
- Retrospective Studies -
- Risk Assessment -
- Statistics, Nonparametric -
- Survival Rate -
- Tachycardia, Ventricular - diagnosis
- Tachycardia, Ventricular - etiology
- Tachycardia, Ventricular - surgery
- Treatment Outcome -
- Find related publications in this database (Keywords)
- ablation
- arrhythmia
- epicardium
- local abnormal ventricular activities
- ventricular tachycardia