Assessing epicardial substrate using intracardiac echocardiography during VT ablation.
Rupa Bala,Jian Fang Ren,Mathew D. Hutchinson,Benoit Desjardins,Cory M. Tschabrunn,Edward P. Gerstenfeld,Rajat Deo,Sanjay Dixit,Fermin C. Garcia,Joshua M. Cooper,David Lin,Michael P. Riley,Wendy S. Tzou,Ralph J. Verdino,Andrew E. Epstein,David J. Callans,Francis E. Marchlinski +16 more
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TLDR
Findings suggest that ICE imaging may be useful to identify epicardial substrate in NICM, and increased echogenicity in the lateral wall of the LV that correlated to abnormal epicardia substrate is identified.Abstract:
Background— Intracardiac echocardiography (ICE) has played a limited role in defining the substrate for ventricular tachycardia (VT). The purpose of this study was to assess whether ICE could identify abnormal epicardial substrate in patients with nonischemic cardiomyopathy (NICM) and VT.
Methods and Results— We studied 18 patients with NICM and recurrent VT who had abnormal echogenicity identified on ICE imaging. Detailed left ventricular (LV) endocardial and epicardial electroanatomic mapping was performed in all patients. Low-voltage areas (<1.0 mV) in the epicardium were analyzed. ICE imaging in the NICM group was compared to a control group of 30 patients with structurally normal hearts who underwent ICE imaging for other ablation procedures. In 18 patients (age, 53±13 years; 17 men) with NICM (ejection fraction, 37±13%), increased echogenicity was identified in the lateral LV by ICE imaging. LV endocardial electroanatomic mapping identified normal voltage in 9 patients and at least 1 confluent low-voltage area (6.6 cm2; minimum-maximum, 2.1–31.7 cm2) in 9 patients (5 posterolateral LV, 4 perivalvular LV). Detailed epicardial mapping revealed areas of low voltage (39 cm2; minimum-maximum, 18.5–96.3 cm2) and abnormal, fractionated electrograms in all 18 patients (15 posterolateral LV, 3 lateral LV). In all patients, the epicardial scar identified by electroanatomic mapping correlated with the echogenic area identified on ICE imaging. ICE imaging identified no areas of increased echogenicity in the control group.
Conclusions— ICE imaging identified increased echogenicity in the lateral wall of the LV that correlated to abnormal epicardial substrate. These findings suggest that ICE imaging may be useful to identify epicardial substrate in NICM.read more
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Journal ArticleDOI
2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias.
Edmond M. Cronin,Frank Bogun,Philippe Maury,Petr Peichl,Minglong Chen,Narayanan Namboodiri,Aguinaga L,Leite Lr,Sana M. Al-Khatib,Elad Anter,Antonio Berruezo,David J. Callans,M. Chung,Phillip S. Cuculich,Andre d'Avila,Barbara J. Deal,Della Bella P,Thomas Deneke,Timm Dickfeld,Hadid C,Haris M. Haqqani,George Neal Kay,Rakesh Latchamsetty,Francis E. Marchlinski,John M. Miller,Akihiko Nogami,Akash R. Patel,Rajeev Kumar Pathak,Sáenz Morales Lc,Pasquale Santangeli,John L. Sapp,Andrea Sarkozy,Kyoko Soejima,William G. Stevenson,Usha B. Tedrow,Wendy S. Tzou,Niraj Varma,Katja Zeppenfeld +37 more
TL;DR: This document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
Journal ArticleDOI
2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias
Edmond M. Cronin,Frank Bogun,Philippe Maury,Petr Peichl,Minglong Chen,Narayanan Namboodiri,Luis Aguinaga,Luiz Roberto Leite,Sana M. Al-Khatib,Elad Anter,Antonio Berruezo,David J. Callans,Mina K. Chung,Phillip S. Cuculich,Andre d'Avila,Barbara J. Deal,Paolo Della Bella,Thomas Deneke,Timm Dickfeld,Claudio Hadid,Haris M. Haqqani,G. Neal Kay,Rakesh Latchamsetty,Francis E. Marchlinski,John M. Miller,Akihiko Nogami,Akash R. Patel,Rajeev Kumar Pathak,Luis C. Saenz Morales,Pasquale Santangeli,John L. Sapp,Andrea Sarkozy,Kyoko Soejima,William G. Stevenson,Usha B. Tedrow,Wendy S. Tzou,Niraj Varma,Katja Zeppenfeld +37 more
TL;DR: This document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
Journal ArticleDOI
Use of Intracardiac Echocardiography in Interventional Cardiology: Working With the Anatomy Rather Than Fighting It.
Andres Enriquez,Luis Saenz,Raphael Rosso,Frank E. Silvestry,David J. Callans,Francis E. Marchlinski,Fermin C. Garcia +6 more
TL;DR: This state-of-the-art review provides guidance on how to conduct a comprehensive ICE survey and summarize the main applications of ICE in a variety of structural and electrophysiology procedures.
Journal ArticleDOI
2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias.
Edmond M. Cronin,Frank Bogun,Philippe Maury,Petr Peichl,Minglong Chen,Narayanan Namboodiri,Luis Aguinaga,Luiz Roberto Leite,Sana M. Al-Khatib,Elad Anter,Antonio Berruezo,David J. Callans,Mina K. Chung,Phillip S. Cuculich,Andre d'Avila,Barbara J. Deal,Paolo Della Bella,Thomas Deneke,Timm Dickfeld,Claudio Hadid,Haris M. Haqqani,G. Neal Kay,Rakesh Latchamsetty,Francis E. Marchlinski,John M. Miller,Akihiko Nogami,Akash R. Patel,Rajeev Kumar Pathak,Luis C. Saenz Morales,Pasquale Santangeli,John L. Sapp,Andrea Sarkozy,Kyoko Soejima,William G. Stevenson,Usha B. Tedrow,Wendy S. Tzou,Niraj Varma,Katja Zeppenfeld +37 more
TL;DR: This document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow‐up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
Journal ArticleDOI
2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias: executive summary
Edmond M. Cronin,Frank Bogun,Philippe Maury,Petr Peichl,Minglong Chen,Narayanan Namboodiri,Luis Aguinaga,Luiz Roberto Leite,Sana M. Al-Khatib,Elad Anter,Antonio Berruezo,David J. Callans,Mina K. Chung,Phillip S. Cuculich,Andre d'Avila,Barbara J. Deal,Paolo Della Bella,Thomas Deneke,Timm Dickfeld,Claudio Hadid,Haris M. Haqqani,G. Neal Kay,Rakesh Latchamsetty,Francis E. Marchlinski,John M. Miller,Akihiko Nogami,Akash R. Patel,Rajeev Kumar Pathak,Luis C. Saenz Morales,Pasquale Santangeli,John L. Sapp,Andrea Sarkozy,Kyoko Soejima,William G. Stevenson,Usha B. Tedrow,Wendy S. Tzou,Niraj Varma,Katja Zeppenfeld +37 more
TL;DR: This document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
References
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Linear Ablation Lesions for Control of Unmappable Ventricular Tachycardia in Patients With Ischemic and Nonischemic Cardiomyopathy
TL;DR: Radiofrequency linear endocardial lesions extending from the dense scar to the normal myocardium or anatomic boundary seem effective in controlling unmappable VT.
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A New Technique to Perform Epicardial Mapping in the Electrophysiology Laboratory
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Catheter Ablation in Patients With Multiple and Unstable Ventricular Tachycardias After Myocardial Infarction Short Ablation Lines Guided by Reentry Circuit Isthmuses and Sinus Rhythm Mapping
Kyoko Soejima,Makoto Suzuki,William H. Maisel,Corinna Brunckhorst,Etienne Delacrétaz,Louis Blier,Stanley Tung,Hafiza Khan,William G. Stevenson +8 more
TL;DR: This study assesses the feasibility of guiding RF line placement by mapping to identify a reentry circuit isthmus to ablate multiple and unstable ventricular tachycardias through infarct (MI).
Journal ArticleDOI
Endocardial Unipolar Voltage Mapping to Detect Epicardial Ventricular Tachycardia Substrate in Patients With Nonischemic Left Ventricular Cardiomyopathy
Mathew D. Hutchinson,Edward P. Gerstenfeld,Benoit Desjardins,Rupa Bala,Michael P. Riley,Fermin C. Garcia,Sanjay Dixit,David Lin,Wendy S. Tzou,Joshua M. Cooper,Ralph J. Verdino,David J. Callans,Francis E. Marchlinski +12 more
TL;DR: In this paper, the authors used a larger electric field of view (FOV) to identify EPI low bipolar voltage regions in patients with LVCM undergoing ventricular tachycardia (Vt) ablation.