2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias: Executive summary

Cronin, Edmond M.; Bogun, Frank; Maury, Philippe; Peichl, Petr; Chen, Minglong; Namboodiri, Narayanan; Aguinaga, Luis; Leite, Luiz Roberto; Al‐Khatib, Sana M.; Anter, Elad; Berruezo, Antonio; Callans, David J.; Chung, Mina K.; Cuculich, Phillip S.; Reddy, Vivek Y.; Deal, Barbara J.; Bella, Paolo Della; Deneke, Thomas; Dickfeld, Timm; Hadid, Claudio; Haqqani, Haris M.; Kay, G. Neal; Latchamsetty, Rakesh; Marchlinski, Francis E.; Miller, John M.; Nogami, Akihiko; Patel, Akash R.; Pathak, Rajeev K.; Morales, Luis C. Sàenz; Santangeli, Pasquale; Sapp, John L.; Sarkozy, Andrea; Soejima, Kyoko; Stevenson, William G.; Tedrow, Usha B.; Tzou, Wendy S.; Varma, Niraj; Zeppenfeld, Katja

doi:10.1016/j.hrthm.2019.03.014

Cited by 92 publications

(116 citation statements)

References 353 publications

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“…Based on current recommendations, direct oral anticoagulants should be withheld for 24 to 48 hours pre‐ablation. Pre‐procedure interruption of vitamin K antagonists is also recommended, with a target INR of <1.5 . Among patients with a high risk of thromboembolism, including patients with mechanical mitral valves, bridging with heparin is recommended, which may increase the risk of arterial access site complications .…”

Section: Techniques For Ra Accessmentioning

confidence: 99%

“…Pre‐procedure interruption of vitamin K antagonists is also recommended, with a target INR of <1.5 . Among patients with a high risk of thromboembolism, including patients with mechanical mitral valves, bridging with heparin is recommended, which may increase the risk of arterial access site complications . Arterial closure devices may be considered to reduce risk in these patients (discussed in more detail in subsequent sections) .…”

Section: Techniques For Ra Accessmentioning

confidence: 99%

“…Arterial closure devices may be considered to reduce risk in these patients (discussed in more detail in subsequent sections) . In terms of intraprocedural anticoagulation, endocardial mapping and ablation requires full heparinization with a target activated clotting time of >300 seconds …”

Section: Techniques For Ra Accessmentioning

confidence: 99%

“…Techniques for femoral arterial access have been reviewed in detail previously and are only discussed briefly here . The routine use of vascular ultrasound is recommended to reduce the risk of access site complications (class 1B indication) . Ultrasound‐guided access is associated with higher rates of first‐pass common femoral artery cannulation and reduced access site complications .…”

Section: Techniques For Ra Accessmentioning

confidence: 99%

“…Intracardiac echocardiography is increasingly used to obviate the need for angiography during cusp mapping and ablation (Figure ). The use of coronary angiography or intracardiac echocardiography is a class 1B recommendation based on current guidelines . Additionally, monitoring of catheter impedance is recommended when mapping in the vicinity of the coronary vessels.…”

Section: Techniques For Ra Accessmentioning

confidence: 99%

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Retrograde aortic access during ventricular tachycardia ablation: Indications, techniques, and challenges

Adlan

Campbell

Fairbairn

et al. 2019

Cardiovasc electrophysiol

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The retrograde aortic (RA) route is a widely used access route for mapping and ablation of ventricular tachycardias (VT) arising from the left ventricular endocardium. With the expanding role of VT ablation in patients with significant comorbidity, the choice between the RA and transseptal access routes is an increasingly important consideration. An individualized decision based on the location of the arrhythmogenic substrate, vascular anatomy, aortic valve morphology, and operator experience is necessary when deciding on the optimal access route. Among patients with challenging vascular anatomy, growing experience from structural interventions such as transcatheter aortic valve replacements and peripheral vascular interventions has provided valuable insights into techniques for safe retrograde access. The present review focuses on patient selection for RA access, potential complications associated with the technique, and optimal approaches for access in patients with challenging vascular or aortic valve anatomy.

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Section: Techniques For Ra Accessmentioning

confidence: 99%

Section: Techniques For Ra Accessmentioning

confidence: 99%

Section: Techniques For Ra Accessmentioning

confidence: 99%

Section: Techniques For Ra Accessmentioning

confidence: 99%

Section: Techniques For Ra Accessmentioning

confidence: 99%

See 3 more Smart Citations

Retrograde aortic access during ventricular tachycardia ablation: Indications, techniques, and challenges

Adlan

Campbell

Fairbairn

et al. 2019

Cardiovasc electrophysiol

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Outcomes Associated With Catheter Ablation of Ventricular Tachycardia in Patients With Cardiac Sarcoidosis

et al. 2022

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IMPORTANCE Ventricular tachycardia (VT) is associated with high mortality in patients with cardiac sarcoidosis (CS), and medical management of CS-associated VT is limited by high failure rates. The role of catheter ablation has been investigated in small, single-center studies.OBJECTIVE To investigate outcomes associated with VT ablation in patients with CS. DESIGN, SETTING, AND PARTICIPANTSThis cohort study from the Cardiac Sarcoidosis Consortium registry (2003-2019) included 16 tertiary referral centers in the US, Europe, and Asia. A total of 158 consecutive patients with CS and VT were included (33% female; mean [SD] age, 52 [11] years; 53% with ejection fraction [EF] <50%).EXPOSURES Catheter ablation of CS-associated VT and, as appropriate, medical treatment. MAIN OUTCOMES AND MEASURESImmediate and short-term outcomes included procedural success, elimination of VT storm, and reduction in defibrillator shocks. The primary long-term outcome was the composite of VT recurrence, heart transplant (HT), or death. RESULTSComplete procedural success (no inducible VT postablation) was achieved in 85 patients (54%). Sixty-five patients (41%) had preablation VT storm that did not recur postablation in 53 (82%). Defibrillator shocks were significantly reduced from a median (IQR) of 2 (1-5) to 0 (0-0) in the 30 days before and after ablation (P < .001). During median (IQR) follow-up of 2.5 (1.1-4.9) years, 73 patients (46%) experienced VT recurrence and 81 (51%) experienced the composite primary outcome. One-and 2-year rates of survival free of VT recurrence, HT, or death were 60% and 52%, respectively. EF less than 50% and myocardial inflammation on preprocedural 18 F-fluorodeoxyglucose positron emission tomography were significantly associated with adverse prognosis in multivariable analysis for the primary outcome (HR, 2.24; 95% CI, 1.37-3.64; P = .001 and HR, 2.93; 95% CI, 1.31-6.55; P = .009, respectively). History of hypertension was associated with a favorable long-term outcome (adjusted HR, 0.51; 95% CI, 0.28-0.92; P = .02). CONCLUSIONS AND RELEVANCEIn this observational study of selected patients with CS and VT, catheter ablation was associated with reductions in defibrillator shocks and recurrent VT storm. Preablation LV dysfunction and myocardial inflammation were associated with adverse long-term prognosis. These data support the role of catheter ablation in conjunction with medical therapy in the management of CS-associated VT.

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