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1.
Herzschrittmacherther Elektrophysiol ; 31(1): 26-32, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32030516

RESUMO

Acute management of patients with ventricular arrhythmia (VA) is aimed at immediate VA termination if the patient is hemodynamically instable and early termination after initial diagnostic work-up if tolerated. Prolonged episodes of VA may lead to hemodynamic and metabolic decompensation and early resumption of normal ventricular activation is warranted. Termination is best performed by electrical cardioversion, anti-tachycardia pacing (if available, in cases with an implanted defibrillator [ICD]) or defibrillation. Antiarrhythmic drug treatment may lead to rhythm stabilization in cases of VA recurrence. Scrutinizing the electrocardiogram (ECG) of VA is extremely helpful to differentiate potential mechanisms, underlying cardiac pathologies and identify treatment options, as well as a differential diagnosis if a ventricular origin is unclear. In general, structural VA should be differentiated from idiopathic and non-structural (idiopathic) VA. On the other hand, based on ECG morphology VA should be classified into monomorphic versus polymorphic ventricular tacyhcardia (VT)/ventricular fibrillation (VF). Polymorphic VT/VF may be related to reversible causes as well as genetically determined arrhythmia syndromes and a specialized treatment pathway may be chosen: (1) VA termination, (2) evaluation and treatment of potential VA causes, (3) acute (medical treatment) and chronic (interventional treatment using catheter ablation) prevention of recurrence and (4) treatment of underlying heart disease, if identified, are crucial pillars of VA management. These patients can be managed in dedicated VT units and by multispecialty teams integrating all potential aspects of rhythm stabilization and treating underlying cardiac abnormalities. Heart failure management in patients with reduced left ventricular function may be crucial for the long-term prognosis.


Assuntos
Ablação por Cateter , Taquicardia Ventricular , Desfibriladores Implantáveis , Cardioversão Elétrica , Eletrocardiografia , Humanos , Taquicardia Ventricular/cirurgia , Fibrilação Ventricular
2.
Herzschrittmacherther Elektrophysiol ; 30(4): 349-355, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31713027

RESUMO

Catheter-based ablation of ventricular tachycardia (VT) is increasingly used in clinical practice. The reported success rates are especially high in idiopathic VT. In randomized controlled clinical trials like VANISH, ablation of scar-associated VT was superior in terms of mortality when compared to antiarrhythmic therapy. Treatment at experienced centers, e.g., using state-of-the-art electroanatomical mapping systems, is a promising option for these complex and often multimorbid patients.


Assuntos
Ablação por Cateter , Taquicardia Ventricular , Antiarrítmicos , Cicatriz , Humanos , Taquicardia Ventricular/cirurgia , Resultado do Tratamento
3.
Clin Cardiol ; 42(10): 1041-1050, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31411347

RESUMO

Despite the technical improvements made in recent years, the overall long-term success rate of ventricular tachycardia (VT) ablation in patients with ischemic cardiomyopathy remains disappointing. This unsatisfactory situation has persisted even though several approaches to VT substrate ablation allow mapping and ablation of noninducible/nontolerated arrhythmias. The current substrate mapping methods present some shortcomings regarding the accurate definition of the true scar, the modality of detection in sinus rhythm of abnormal electrograms that identify sites of critical channels during VT and the possibility to determine the boundaries of functional re-entrant circuits during sinus or paced rhythms. In this review, we focus on current and proposed ablation strategies for VT to provide an overview of the potential/real application (and results) of several ablation approaches and future perspectives.


Assuntos
Mapeamento Potencial de Superfície Corporal/métodos , Ablação por Cateter/métodos , Sistema de Condução Cardíaco/fisiopatologia , Isquemia Miocárdica/complicações , Taquicardia Ventricular/diagnóstico , Humanos , Isquemia Miocárdica/diagnóstico , Prognóstico , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/cirurgia
4.
J Cardiovasc Med (Hagerstown) ; 20(9): 597-605, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31318839

RESUMO

METHODS: We performed a nationwide survey on the current practice of ventricular tachycardia catheter ablation in Italy during the year 2016. RESULTS: Among 145 operators participating in the survey, 58 (40.0%) did not perform any ventricular tachycardia ablation in 2016. Among those performing ventricular tachycardia ablation, 9 operators (6.2%) performed only right ventricular endocardial catheter ablation, 52 (35.9%) performed endocardial catheter ablation both in the right and left ventricle (LV) and 26 (17.9%) performed both endocardial and epicardial LV catheter ablations. Seventy operators (89.7%) among the 78 performing LV and epicardial ablations treated patients with ischemic cardiomyopathy; ablations in the setting of other causes were less frequently performed. The following were considered as minimum requirements for ventricular tachycardia ablation: presence of a three-dimensional mapping system (120 operators, 82.8%), ICU in the hospital (118 operators, 81.4%), operator's training in high volume centers (93 operators, 64.1%). Twenty-eight operators (19.3%) performed catheter ablation in patients with electrical storm only after hemodynamic stabilization, 41 operators (28.3%) also during the acute phase and 9 operators (6.2%) never performed catheter ablation in electrical storm patients; the remaining 67 operators did not perform ventricular tachycardia ablation at all, or performed ablations only in the right ventricle. CONCLUSION: The present survey provides a snapshot of the current invasive treatment of ventricular tachycardia by catheter ablation. The procedure, especially in the setting of ischemic cardiomyopathy, is performed nationwide. Complex cases, including those with electrical storm, should be managed within a preestablished integrated network of regional referral centers able to transfer patients as soon as possible.


Assuntos
Ablação por Cateter/tendências , Prestação Integrada de Cuidados de Saúde/tendências , Padrões de Prática Médica/tendências , Taquicardia Ventricular/cirurgia , Ablação por Cateter/efeitos adversos , Pesquisas sobre Serviços de Saúde , Disparidades em Assistência à Saúde/tendências , Humanos , Itália/epidemiologia , Transferência de Pacientes/tendências , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Regionalização/tendências , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/epidemiologia , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento
5.
Int J Sports Med ; 40(10): 657-662, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31342478

RESUMO

Competitive sports and intensive exercise are associated with adverse outcomes in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). This study aimed to assess the role of exercise on long-term results of radiofrequency catheter ablation (RFCA) therapy of ventricular tachycardia (VT) in patients with ARVD/C. Exercise participation was evaluated by telephone or in-person interviews in patients from our ARVD/C registry with previous VT ablation (38 patients, 26 males, age 52.6±14.1years). Of 38 patients, 30 were involved in sports activities before RFCA. Only the minority of our patient population (21.1%) had a sedentary lifestyle before RFCA; 42.1 and 36.8% reported recreational or competitive sports, respectively. During the follow-up period of 52.5±31.4 months, 23 of the total 38 patients with previous RFCA (60.5%) remained free from VT recurrence. In univariate and binary logistic regression analysis, only advanced age was significantly associated with VT recurrence, with a hazard ratio of 1.15, and 95% confidence interval 1.05-1.26 (p=0.004). The results of our observational study indicate that recreational sports do not impair long-term results after RFCA treatment compared with a sedentary lifestyle. Furthermore, the dynamic component of recreational exercise did not affect the outcome of VT ablation in our patient population. Recreational exercise at low to moderate intensity is not associated with an increased risk for VT recurrence after catheter ablation in patients with ARVD/C.


Assuntos
Displasia Arritmogênica Ventricular Direita/cirurgia , Ablação por Cateter , Exercício , Taquicardia Ventricular/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Resultado do Tratamento
6.
Am J Case Rep ; 20: 810-815, 2019 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-31177265

RESUMO

BACKGROUND Response to cardiac resynchronization therapy (CRT) is variable among patients. Extensive scar tissue burden has been characterized as a negative predictor of significant response. Whereas mid-term and long-term response has been thoroughly investigated in randomized clinical trials; however, little is known about acute hemodynamic effects of biventricular pacing. CASE REPORT We report a case of an elderly female patient with severe ischemic cardiomyopathy and a large anterior wall aneurysm, who received right ventricular and biventricular pacing during ablation of incessant pleomorphic ventricular tachycardia. During the procedure, biventricular pacing was associated with a 20% acute increase in systolic blood pressure compared to right ventricular pacing, although there was no acute or long-term effect on left ventricular function. CONCLUSIONS The acute hemodynamic effect of CRT in our patient suggests an effect of CRT even in patients with negative predictors of CRT response such as severe ischemic cardiomyopathy with a large aneurysm. Although no marked increase in left ventricular function might be observed, the acute effect of CRT might contribute to stabilization of heart failure in these patients.


Assuntos
Terapia de Ressincronização Cardíaca/métodos , Ablação por Cateter/métodos , Aneurisma Cardíaco/complicações , Hemodinâmica/fisiologia , Isquemia Miocárdica/diagnóstico por imagem , Taquicardia Ventricular/cirurgia , Idoso de 80 Anos ou mais , Dispneia/diagnóstico , Dispneia/etiologia , Eletrocardiografia/métodos , Feminino , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/cirurgia , Humanos , Imagem Tridimensional/métodos , Multimorbidade , Isquemia Miocárdica/complicações , Isquemia Miocárdica/terapia , Prognóstico , Medição de Risco , Taquicardia Ventricular/diagnóstico por imagem , Resultado do Tratamento
7.
Cardiol Young ; 29(6): 793-799, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169097

RESUMO

INTRODUCTION: Catheter ablation of left posterior fascicular ventricular tachycardia in the pediatric population remains challenging, and most studies about this topic have been conducted on adult patients. This study aimed to assess the clinical presentation features and outcomes of catheter ablations performed using limited fluoroscopy with three-dimensional electroanatomic mapping system guidance in a pediatric left posterior fascicular ventricular tachycardia patient group. METHODS: A total of 20 consecutive patients undergoing left posterior fascicular ventricular tachycardia ablation at a single tertiary centre were enrolled. All children with left posterior fascicular ventricular tachycardia underwent electrophysiological studies using the EnSite NavX system guidance. Ablations were performed during the sinus rhythm based on the Purkinje potentials in all patients. RESULTS: The mean patient age was 12.7 years (range 2-16), and the mean patient weight was 51 kg (range 11-84). The mean procedure and median fluoroscopy times were 143.1 minutes and 3.4 minutes, respectively. No fluoroscopy was used in three patients. Acute success was achieved in 19 patients (95%). During a mean follow-up of 38.6 ± 19.35 months, left posterior fascicular ventricular tachycardia recurred in four patients (20%). Repeat ablations were performed successfully in those patients who developed recurrences. No complications were seen. CONCLUSIONS: Catheter ablation of left posterior fascicular ventricular tachycardia in children can be performed safely and effectively with low fluoroscopy exposure using a three-dimensional electroanatomic mapping system.


Assuntos
Mapeamento Potencial de Superfície Corporal/métodos , Ablação por Cateter/métodos , Fluoroscopia/métodos , Sistema de Condução Cardíaco/fisiopatologia , Cirurgia Assistida por Computador/métodos , Taquicardia Ventricular/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Sistema de Condução Cardíaco/cirurgia , Humanos , Imagem Tridimensional , Masculino , Recidiva , Estudos Retrospectivos , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento
8.
Circ Arrhythm Electrophysiol ; 12(6): e007336, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31113232

RESUMO

Background Radiofrequency ablation of intramural ventricular substrate is often limited by insufficient tissue penetration despite high energy settings. As lesion dimensions have a direct and negative relationship to impedance, reducing the baseline impedance may increase the ablation effect on deep ventricular tissue. Methods This study included 16 patients with ventricular tachycardia or frequent ventricular premature complexes refractory to ablation with irrigated catheters. After a failed response to radiofrequency ablation, impedance was modulated by adding or repositioning return patches in an attempt to decrease the circuit impedance. Ablation was repeated at a similar location and power settings, and the effect on arrhythmia suppression and adverse effects were evaluated. Results Six patients with idiopathic ventricular premature complexes originating from the left ventricular summit (n=4) or papillary muscles (n=2), 6 patients with noninfarct related ventricular tachycardia and 4 patients with infarct-related ventricular tachycardia had unsuccessful response to radiofrequency ablation at critical sites (number of applications: 10.4±3.1, power: 42.3±2.9 W, duration: 55.3±25.5 seconds, impedance reduction: 14.6±3.5 Ω, low-ionic solution was used in 81.25%). Modulating the return patches resulted in reduced baseline impedance (111.7±8.2 versus 134.7±6.6 Ω, P<0.0001), increased current output (0.6±0.02 versus 0.56±0.02 Amp; P<0.0001) and greater impedance drop (16.8±3.0 Ω, P<0.001). Repeat ablation at similar locations had a successful effect in 12 out of 16 (75.0%) patients. During a follow-up duration of 13±5 months, 10 out of 12 (83.3%) patients remained free of arrhythmia recurrence. The frequency of steam pops was similar between the higher and lower baseline impedance settings (7.1 versus 8.2%; P=0.74). Conclusions In patients with deep ventricular substrate, reducing the baseline impedance is a simple, safe, and effective technique for increasing the effect of radiofrequency ablation. However, its combination with low-ionic solutions may increase the risk for steam pops and neurological events.


Assuntos
Ablação por Cateter/instrumentação , Ventrículos do Coração/cirurgia , Taquicardia Ventricular/cirurgia , Complexos Ventriculares Prematuros/cirurgia , Potenciais de Ação , Idoso , Ablação por Cateter/efeitos adversos , Impedância Elétrica , Feminino , Frequência Cardíaca , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Recidiva , Estudos Retrospectivos , Fatores de Risco , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Fatores de Tempo , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/fisiopatologia
10.
Circ Arrhythm Electrophysiol ; 12(6): e007293, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31122054

RESUMO

Background Catheter ablation of ventricular tachycardia (VT) in structural heart disease is challenging because of noninducibility or hemodynamic compromise. Ablation often depends on elimination of local abnormal ventricular activities (LAVAs) but which may be hidden in far-field signal. We investigated whether altering activation wavefront affects activation timing and LAVA characterization and allows a better understanding of isthmus anatomy. Methods Patients with ischemic cardiomyopathy underwent mapping using the ultra-high density Rhythmia system (Boston Scientific). Maps were generated for all stable VTs and with pacing from the atrium, right ventricular apex, and an left ventricular branch of the coronary sinus. Results Fifty-six paced maps and 23 VT circuits were mapped in 22 patients. In 79% of activation maps, there was ≥1 line of block in the paced conduction wavefront, with 93% having fixed block and 32% showing functional partial block. Bipolar scar was larger with atrial than right ventricular (31.7±18.5 versus 27.6±16.3 cm2, P=0.003) or left ventricular pacing (31.7±18.5 versus 27.0±19.2 cm2, P=0.009); LAVA areas were smaller with atrial than right ventricular (12.3±10.5 versus 18.4±11.0 cm2, P<0.001) or left ventricular pacing (12.3±10.5 versus 17.1±10.7 cm2, P<0.001). LAVA areas were larger with wavefront propagation perpendicular versus parallel to the line of block along isthmus boundaries (19.3±7.1 versus 13.6±7.4 cm2, P=0.01). All patients had successful VT isthmus ablation. In 11±8 months follow-up, 2 patients had a recurrence. Conclusions Wavefronts of conduction slowing/block may aid identification of critical isthmuses in unmappable VTs. Altering the activation wavefront leads to significant differences in conduction properties of myocardial tissue, along with scar and LAVA characterization. In patients where few LAVAs are identified during substrate mapping, using an alternate activation wavefront running perpendicular to the VT isthmus may increase sensitivity to detect arrhythmogenic substrate and critical sites for reentry.


Assuntos
Potenciais de Ação , Ablação por Cateter , Técnicas Eletrofisiológicas Cardíacas , Frequência Cardíaca , Ventrículos do Coração/cirurgia , Taquicardia Ventricular/cirurgia , Idoso , Estimulação Cardíaca Artificial , Ablação por Cateter/efeitos adversos , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recidiva , Fatores de Risco , Volume Sistólico , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda
12.
J Interv Card Electrophysiol ; 55(1): 55-62, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31020468

RESUMO

PURPOSE: Targets for substrate-based catheter ablation of scar-related ventricular tachycardia (VT) include sites with fractionated and late potentials (LPs). We hypothesized that in patients with cardiac resynchronization therapy (CRT), the pacing mode may influence the timing of abnormal electrograms (EGMs) relative to the surface QRS complex. METHODS: We assessed bipolar EGM characteristics in left ventricular low bipolar voltage areas (< 1.5 mV) from 10 patients with coronary disease and a CRT device undergoing catheter ablation for VT. EGMs at 81 sites were analyzed during three different pacing modes (biventricular (BiV), right ventricular (RV)-only, and left ventricular (LV)-only) pacing. RESULTS: Stimulus to end of local electrogram duration (Stim-to-eEGM) depended significantly on the stimulation site (BiV, LV, or RV, p = 0.032). Single-chamber pacing unmasked LPs, not present during BiV pacing, in three patients. In another three patients, a concomitant increase in stimulus to end of surface QRS duration caused by single-site pacing compensated for the increase in Stim-to-eEGM duration, thereby prohibiting LP unmasking. CONCLUSION: The sequence of ventricular activation, as determined by the pacing site in patients with CRT devices, has a major influence on the detection of late potentials during substrate-guided ablation. Further study is warranted to define the optimal approaches, including the rhythm, for substrate mapping, but our findings suggest that BiV pacing may be most likely to obscure detection of late potentials as compared to single-site pacing.


Assuntos
Terapia de Ressincronização Cardíaca/métodos , Ablação por Cateter/métodos , Cicatriz/cirurgia , Cardiopatias/terapia , Taquicardia Ventricular/cirurgia , Idoso , Cicatriz/fisiopatologia , Eletrocardiografia , Mapeamento Epicárdico , Humanos , Masculino , Estudos Prospectivos , Taquicardia Ventricular/fisiopatologia
16.
Circ Arrhythm Electrophysiol ; 12(5): e007023, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31006314

RESUMO

BACKGROUND: Postinfarction ventricular tachycardia (VT) generally involves myocardial fibers surrounded by scar. Calcification of scar tissue has been described, but the relationship between calcifications within endocardial scar and VTs is unclear. The purpose of this study was to assess the prevalence of myocardial calcifications as detected by cardiac computed tomography (CT) and the benefit for mapping and ablation focusing on nontolerated VTs. METHODS: Fifty-six consecutive postinfarction patients had a cardiac CT performed before a VT ablation procedure. Another 56 consecutive patients with prior infarction without VT who had cardiac CTs served as a control group. RESULTS: Myocardial calcifications were identified in 39 of 56 patients (70%) in the postinfarction group with VT, compared with 6 of 56 patients (11%) in the control group without VT. Calcifications were associated with VT when compared with a control group. A calcification volume of 0.538 cm3 distinguished patients with calcification-associated VT from patients without calcification-associated VTs (area under the curve, 0.87; sensitivity, 0.87; specificity, 0.88). Myocardial calcifications corresponded to areas of electrical nonexcitability and formed a border for reentry circuits for 49 VTs (33% of all VTs for which target sites were identified) in 24 of 39 patients (62%) with myocardial calcifications. A nonconfluent calcification pattern was associated with VT target sites independent of calcification volume ( P=0.01). CONCLUSIONS: Myocardial calcifications detected by cardiac CT in patients with prior infarction are associated with VT. The calcifications correspond to areas of unexcitability and represent a fixed boundary of reentry circuits that can be visualized by CT. Calcifications correspond to effective ablation sites in >1/3 of patients with postinfarction VT.


Assuntos
Calcinose/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Infarto do Miocárdio/complicações , Miocárdio/patologia , Taquicardia Ventricular/diagnóstico por imagem , Idoso , Calcinose/etiologia , Calcinose/patologia , Técnicas de Imagem de Sincronização Cardíaca , Estudos de Casos e Controles , Ablação por Cateter , Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/patologia , Valor Preditivo dos Testes , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/cirurgia
17.
Circ Arrhythm Electrophysiol ; 12(4): e007120, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30947511

RESUMO

BACKGROUND: The accuracy of ECG imaging (ECGI) in structural heart disease remains uncertain. This study aimed to provide a detailed comparison of ECGI and contact-mapping system (CARTO) electrograms. METHODS: Simultaneous epicardial mapping using CARTO (Biosense-Webster, CA) and ECGI (CardioInsight) in 8 patients was performed to compare electrogram morphology, activation time (AT), and repolarization time (RT). Agreement between AT and RT from CARTO and ECGI was assessed using Pearson correlation coefficient, ρ AT and ρ RT, root mean square error, E AT and E RT, and Bland-Altman plots. RESULTS: After geometric coregistration, 711 (439-905; median, first-third quartiles) ECGI and CARTO points were paired per patient. AT maps showed ρ AT=0.66 (0.53-0.73) and E AT=24 (21-32) ms, RT maps showed ρ RT=0.55 (0.41-0.71) and E RT=51 (38-70) ms. The median correlation coefficient measuring the morphological similarity between the unipolar electrograms was equal to 0.71 (0.65-0.74) for the entire signal, 0.67 (0.59-0.76) for QRS complexes, and 0.57 (0.35-0.76) for T waves. Local activation map correlation, ρ AT, was lower when default filters were used (0.60 (0.30-0.71), P=0.053). Small misalignment of the ECGI and CARTO geometries (below ±4 mm and ±4°) could introduce variations in the median ρ AT up to ±25%. Minimum distance between epicardial pacing sites and the region of earliest activation in ECGI was 13.2 (0.0-28.3) mm from 25 pacing sites with stimulation to QRS interval <40 ms. CONCLUSIONS: This simultaneous assessment demonstrates that ECGI maps activation and repolarization parameters with moderate accuracy. ECGI and contact electrogram correlation is sensitive to electrode apposition and geometric alignment. Further technological developments may improve spatial resolution.


Assuntos
Eletrocardiografia , Mapeamento Epicárdico , Taquicardia Ventricular/fisiopatologia , Ablação por Cateter , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/cirurgia
19.
Anatol J Cardiol ; 21(4): 187-195, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30930451

RESUMO

OBJECTIVE: To control ventricular arrhythmia in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C), ablation may be required both from the endocardial and epicardial side. In this study, we analyzed the results of contact force-sensing (CFS) catheters in the endo/epicardial ablation of ventricular arrhythmias in ARVD/C. METHODS: We included 17 patients with ARVD/C, 5 of whom had premature ventricular contractions (PVC), and the rest of them were admitted with a ventricular tachycardia (VT) storm, between September 2014 and October 2016. We divided patients into two groups: the PVC and VT groups. Irrigated CFS catheters (Smart Touch, Biosense Webster, Inc.) were utilized in all procedures. RESULTS: In the PVC group, the mean ratio of PVC during the 24-hour Holter monitoring was 31.8+-7.6%. The mean contact force during mapping and ablation in the right ventricle was 13+-1.2 and 12.8+-1.9 grams, respectively. The mean follow-up duration was 15+-3.1 months for the PVC group. The left ventricular ejection fraction improved in all patients (52.8+-10%). All patients in the VT group underwent endo/epicardial ablation, except one. The mean contact force during the endocardium and epicardium mapping was 12.5+-1.2 and 12.5+-4.6 grams, respectively. The mean contact force during ablation for the endocardium and epicardium was 12.1+-1.4 and 12.8+-1.9 grams, respectively. All clinical and non-clinical VTs were ablated successfully, except in 2 patients who still had non-clinical VTs. The mean follow-up was 15.5+-4.5 months. None of the VT patients experienced electrical storm or death. Two patients had single shock, and 1 patient had two shocks during the follow-up. CONCLUSION: Endo/epicardial ablation of ventricular arrhythmias with CFS catheters in ARVD/C seems to be promising.


Assuntos
Displasia Arritmogênica Ventricular Direita/cirurgia , Taquicardia Ventricular/cirurgia , Complexos Ventriculares Prematuros/cirurgia , Adulto , Displasia Arritmogênica Ventricular Direita/fisiopatologia , Ablação por Cateter , Técnicas Eletrofisiológicas Cardíacas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento , Complexos Ventriculares Prematuros/fisiopatologia , Adulto Jovem
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