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Hybrid Ventricular Tachycardia Ablation after Failed Percutaneous Endocardial and Epicardial Ablation.
Haanschoten, Danielle M; Adiyaman, Ahmet; Smit, Jaap Jan J; Delnoy, Peter Paul H M; Ramdat Misier, Anand R; Porta, Fabiano; Storm van Leeuwen, Robert P H; Elvan, Arif.
Afiliação
  • Haanschoten DM; Isala Heart Center, Zwolle, The Netherlands.
  • Adiyaman A; Isala Heart Center, Zwolle, The Netherlands.
  • Smit JJJ; Isala Heart Center, Zwolle, The Netherlands.
  • Delnoy PPHM; Isala Heart Center, Zwolle, The Netherlands.
  • Ramdat Misier AR; Isala Heart Center, Zwolle, The Netherlands.
  • Porta F; Medical Center Leeuwarden, Leeuwarden, The Netherlands.
  • Storm van Leeuwen RPH; Isala Heart Center, Zwolle, The Netherlands.
  • Elvan A; Isala Heart Center, Zwolle, The Netherlands, a.elvan@isala.nl.
Cardiology ; 145(2): 88-94, 2020.
Article em En | MEDLINE | ID: mdl-31707389
INTRODUCTION: Recurrent ventricular tachycardia (VT) after percutaneous ablation is associated with a high morbidity and mortality. We assessed the feasibility of open chest extracorporeal circulation (ECC)-supported 3D multielectrode mapping and targeted VT substrate ablation in patients with previously failed percutaneous endocardial and epicardial VT ablations. METHODS: In patients with previously failed percutaneous endocardial and epicardial VT ablations and a high risk of hemodynamic collapse during the procedure, open chest ECC-supported mapping and ablation were performed in a hybrid EP lab setting. Electro-anatomic maps (3D) were acquired during sinus rhythm and VT using a multielectrode mapping catheter (HD grid; Abbott or Pentaray, Biosense Webster). Irrigated radiofrequency ablations of all inducible VT were performed with a contact force ablation catheter. RESULTS: Hybrid VT ablation was performed in 5 patients with structural heart disease (i.e., 3 with previous old myocardial infarction and 2 with nonischemic cardiomy-opathy) and recurrent VT. Acute procedural success was achieved in all patients. Four patients were successfully weaned off the ECC. In 1 patient with a severely reduced LVEF (16%), damage to the venous graft occurred after sternotomy and that patient died after 1 month. Four patients (80%) remained VT free after a median follow-up of 6 (IQR 4-10) months. CONCLUSION: In high-risk patients with previously failed percutaneous endocardial and epicardial VT ablations, open chest ECC-supported multielectrode epicardial mapping revealed a VT substrate in all of the patients, and targeted epicardial ablation abolished VT substrate in these patients.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Taquicardia Ventricular / Ablação por Cateter / Endocárdio / Mapeamento Epicárdico Tipo de estudo: Etiology_studies Limite: Aged / Humans / Male / Middle aged Idioma: En Revista: Cardiology Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Holanda

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Taquicardia Ventricular / Ablação por Cateter / Endocárdio / Mapeamento Epicárdico Tipo de estudo: Etiology_studies Limite: Aged / Humans / Male / Middle aged Idioma: En Revista: Cardiology Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Holanda