Acute and Long-Term Scar Characterization of Venous Ethanol Ablation in the Left Ventricular Summit.
JACC Clin Electrophysiol
; 9(1): 28-39, 2023 01.
Article
em En
| MEDLINE
| ID: mdl-37166222
ABSTRACT
BACKGROUND:
Venous ethanol ablation (VEA) can be effective for ventricular arrhythmias from the left ventricular summit (LVS); however, there are concerns about excessive ablation by VEA.OBJECTIVES:
The purpose of this study was to delineate and quantify the location, extent, and evolution of ablated tissue after VEA as an intramural ablation technique in the LVS.METHODS:
VEA was performed in 59 patients with LVS ventricular arrhythmias. Targeted intramural veins were selected by electrograms from a 2F octapolar catheter or by guide-wire unipolar signals. Median ethanol delivered was 4 mL (IQR 4-7 mL). Ablated areas were estimated intraprocedurally as increased echogenicity on intracardiac echocardiography (ICE) and incorporated into 3-dimensional maps. In 44 patients, late gadolinium enhancement cardiac magnetic resonance (CMR) imaged VEA scar and its evolution.RESULTS:
ICE-demonstrated increased intramural echogenicity (median volume of 2 mL; IQR 1.7-4.3) at the targeted region of the 3-dimensional maps. Post-ethanol CMR showed intramural scar of 2.5 mL (IQR 2.1-3.5 mL). Early (within 48 hours after VEA) CMR showed microvascular obstruction (MVO) in 30 of 31 patients. Follow-up CMR after a median of 51 (IQR 41-170) days showed evolution of MVO to scar. ICE echogenicity and CMR scar volumes correlated with each other and with ethanol volume. Ventricular function and interventricular septum remained intact.CONCLUSIONS:
VEA leads to intramural ablation that can be tracked intraprocedurally by ICE and creates regions of MVO that are chronically replaced by myocardial scar. VEA scar volume does not compromise septal integrity or ventricular function.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Taquicardia Ventricular
/
Ablação por Cateter
/
Septo Interventricular
Limite:
Humans
Idioma:
En
Revista:
JACC Clin Electrophysiol
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Estados Unidos