Asunto(s)
Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/terapia , Cardiopatías Congénitas/epidemiología , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/prevención & control , Terapia de Resincronización Cardíaca , Ablación por Catéter , Comorbilidad , Desfibriladores Implantables , Técnicas Electrofisiológicas Cardíacas , Accesibilidad a los Servicios de Salud , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/cirugía , Humanos , Marcapaso ArtificialAsunto(s)
Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/terapia , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/terapia , Adulto , American Heart Association/organización & administración , Canadá , Electrofisiología Cardíaca/organización & administración , Terapia de Resincronización Cardíaca , Cardiología/organización & administración , Ablación por Catéter , Niño , Desfibriladores Implantables , Técnicas Electrofisiológicas Cardíacas , Europa (Continente) , Humanos , Marcapaso Artificial , Estados UnidosRESUMEN
AIMS: Current conventional ablation strategies for ventricular tachycardia (VT) aim to interrupt reentrant circuits by creating ablation lesions. However, the critical components of reentrant VT circuits may be located at deep intramural sites. We hypothesized that bipolar ablations would create deeper lesions than unipolar ablation in human hearts. METHODS AND RESULTS: Ablation was performed on nine explanted human hearts at the time of transplantation. Following explant, the hearts were perfused by using a Langendorff perfusion setup. For bipolar ablation, the endocardial catheter was connected to the generator as the active electrode and the epicardial catheter as the return electrode. Unipolar ablation was performed at 50 W with irrigation of 25 mL/min, with temperature limit of 50°C. Bipolar ablation was performed with the same settings. Subsequently, in a patient with an incessant septal VT, catheters were positioned on the septum from both the ventricles and radiofrequency was delivered with 40 W. In the explanted hearts, there were a total of nine unipolar ablations and four bipolar ablations. The lesion depth was greater with bipolar ablation, 14.8 vs. 6.1 mm (P < 0.01), but the width was not different (9.8 vs. 7.8 mm). All bipolar lesions achieved transmurality in contrast to the unipolar ablations. In the patient with a septal focus, bipolar ablation resulted in termination of VT with no inducible VTs. CONCLUSION: By using a bipolar ablation technique, we have demonstrated the creation of significantly deeper lesions without increasing the lesion width, compared with standard ablation. Further clinical trials are warranted to detail the risks of this technique.
Asunto(s)
Ablación por Catéter/métodos , Sistema de Conducción Cardíaco/cirugía , Taquicardia Ventricular/cirugía , Catéteres Cardíacos , Ablación por Catéter/instrumentación , Técnicas Electrofisiológicas Cardíacas , Sistema de Conducción Cardíaco/fisiopatología , Humanos , Técnicas In Vitro , Masculino , Persona de Mediana Edad , Perfusión , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiología , Taquicardia Ventricular/fisiopatología , Irrigación Terapéutica , Resultado del TratamientoRESUMEN
INTRODUCTION: The prevalence of intra-atrial reentrant tachycardia (IART) increases with age in Fontan patients. This study aimed to characterize the atrial electroanatomic substrate for IART late after Fontan surgery. METHODS AND RESULTS: Detailed electroanatomic mapping of the right atrium (RA) was performed in 11 consecutive patients (33 ± 9 years) with older style Fontan circulation (atriopulmonary and atrioventricular connection) who underwent their first radiofrequency catheter ablation (RFCA) for IART. A comparative group of 30 non-Fontan congenital heart disease (CHD) patients were also studied. Fontan patients had larger RA (P = 0.004), larger low-voltage area ≤ 0.5 mV (P = 0.01), and more fractionated potentials (P < 0.001) than non-Fontan CHD patients. RA enlargement correlated significantly with both low-voltage zones (Spearman ρ= 0.68, P < 0.001) and fractionated potentials (Spearman ρ= 0.48, P = 0.001). Among Fontan patients, both age and time since Fontan surgery were significantly correlated to the amount of low-voltage areas (Spearman ρ= 0.87, P < 0.001; Spearman ρ= 0.63, P = 0.04, respectively). Successful RFCA was accomplished in 30 (73%) patients and was less likely in Fontan patients (54% vs 83%, P = 0.04). Larger RA was significantly associated with a lower success rate (P = 0.04). During a follow-up duration of 2.3 ± 1.6 years, IART recurred in 47% of patients. Larger RA size and larger low-voltage areas predicted IART recurrence after RFCA. CONCLUSION: Fontan patients demonstrate progressive adverse atrial electrical remodeling with increasing age and time since surgery. Newer strategies beyond surgical incisions, such as pharmacotherapies that retard the progression of atrial fibrosis, may be required to reduce the long-term risk of atrial arrhythmias.