Catheter ablation of ventricular tachycardia in patients with electrical storm, with a special focus on patients with Chagas disease

Hadid, Claudio; Toro, Darío Di; Celano, Leonardo; Martinenghi, Nicolás; Antezana-Chaves, Edgar; Gallino, Sebastián; Dubner, Sérgio; Labadet, Carlos

doi:10.1007/s10840-020-00915-7

Cited by 3 publications

(3 citation statements)

References 18 publications

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“…The effectiveness of RFCA has been evaluated in Chagas cardiomyopathy. After 35 months of follow-up, 92.1% of patients with electrical storm and 60.5% of patients with VT had been free from the electrical storm and VT in a prospective study with 38 patients (16 with Chagas cardiomyopathy) receiving RFCA [ 114 ].…”

Section: Outcomes Of Rfca In Different Entities Of Acmmentioning

confidence: 99%

Catheter Ablation in Arrhythmic Cardiac Diseases: Endocardial and Epicardial Ablation

Cheng¹,

Chung²,

Lin³

et al. 2022

Rev. Cardiovasc. Med.

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Arrhythmogenic cardiomyopathy (ACM) is a group of arrhythmogenic disorders of the myocardium that are not caused by ischemic, hypertensive, or valvular heart disease. The clinical manifestations of ACMs may overlap those of dilated cardiomyopathy, complicating the differential diagnosis. In several ACMs, ventricular tachycardia (VT) has been observed at an early stage, regardless of the severity of the disease. Therefore, preventing recurrences of VT can be a clinical challenge. There is a wide range of efficacy and side effects associated with the use of antiarrhythmic drugs (AADs) in the treatment of VT. In addition to AADs, patients with ACM and ventricular tachyarrhythmias may benefit from catheter ablation, especially if they are drug-refractory. The differences in pathogenesis between the various types of ACMs can lead to heterogeneous distributions of arrhythmogenic substrates, non-uniform ablation strategies, and distinct ablation outcomes. Ablation has been documented to be effective in eliminating ventricular tachyarrhythmias in arrhythmogenic right ventricular dysplasia (ARVC), sarcoidosis, Chagas cardiomyopathy, and Brugada syndrome (BrS). As an entity that is rare in nature, ablation for ventricular tachycardia in certain forms of ACM may only be reported through case reports, such as amyloidosis and left ventricular noncompaction. Several types of ACMs, including ARVC, sarcoidosis, Chagas cardiomyopathy, BrS, and left ventricular noncompaction, may exhibit diseased substrates within or adjacent to the epicardium that may be accountable for ventricular arrhythmogenesis. As a result, combining endocardial and epicardial ablation is of clinical importance for successful ablation. The purpose of this article is to provide a comprehensive overview of the substrate characteristics, ablation strategies, and ablation outcomes of various types of ACMs using endocardial and epicardial approaches.

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Section: Outcomes Of Rfca In Different Entities Of Acmmentioning

confidence: 99%

Catheter Ablation in Arrhythmic Cardiac Diseases: Endocardial and Epicardial Ablation

Cheng¹,

Chung²,

Lin³

et al. 2022

Rev. Cardiovasc. Med.

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“…Long-term outcome of CCC patients was similar to that of the overall population in terms of freedom from VT/ventricular fibrillation (62.5% vs 59.1%; P 5 .832); freedom from ES (93.8% vs 90.9%; P 5 .748); and overall mortality (25% vs 31.8%; P 5 .729). 93 During the ablation procedure, a detailed electrophysiological study is required, in combination with high-density 3-dimensional maps (Figure 4). As mentioned in the section on Pathophysiology of arrhythmias in Chagas cardiomyopathy, the areas of fibrosis and scar tend to be located in the apical, inferolateral, and basal regions of the LV (Figure 5), with transmural or subepicardial substrates (Figure 6 and Supplemental Video 1).…”

Section: Mapping Strategies and Catheter Ablation Of Vtmentioning

confidence: 99%

Advanced management of ventricular arrhythmias in chronic Chagas cardiomyopathy

Santacruz¹,

Rosas²,

Hardy

et al. 2021

Heart Rhythm O2

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“…In the RFCA of ventricular tachycardia (VT), it is widely accepted that the endocardial approach can fail in certain circumstances while the epicardial approach may be effective, allowing the creation of a thermal lesion that reaches the substrate of the arrhythmia. [1][2][3][4][5][6][7][8][9][10][11] The epicardial approach is a transthoracic technique originally proposed by Sosa et al 1 and based on pericardial puncture, which means the catheter tip can be introduced into the pericardial space to apply RF power directly on the epicardium. Although bipolar ablation (which applies RF power between two active electrodes on each side of the ventricular wall) has been suggested to ablate VT, 12 most procedures are really monopolar, that is, an RF current flows between the active electrode and the DP.…”

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confidence: 99%

Effect of dispersive electrode position (anterior vs. posterior) in epicardial radiofrequency ablation of ventricular wall: A computer simulation study

Irastorza,

Hadid,

Berjano

2024

Numer Methods Biomed Eng

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An epicardial approach is often used in radiofrequency (RF) catheter ablation to ablate ventricular tachycardia when an endocardial approach fails. Our objective was to analyze the effect of the position of the dispersive patch (DP) on lesion size using computer modeling during epicardial approach. We compared the posterior position (patient's back), commonly used in clinical practice, to the anterior position (patient's chest). The model considered ventricular wall thicknesses between 4 and 8 mm, and electrode insertion depths between .3 and .7 mm. RF pulses were simulated with 20 W of power for 30 s duration. Statistically significant differences (P < .001) were found between both DP positions in terms of baseline impedance, RF current (at 15 s) and thermal lesion size. The anterior position involved lower impedance (130.8 ± 4.7 vs. 146.2 ± 4.9 Ω) and a higher current (401.5 ± 5.6 vs. 377.5 ± 5.1 mA). The anterior position created lesion sizes larger than the posterior position: 8.9 ± 0.4 vs. 8.4 ± 0.4 mm in maximum width, 8.6 ± 0.4 vs. 8.1 ± 0.4 mm in surface width, and 4.5 ± 0.4 vs. 4.3 ± 0.4 mm in depth. Our results suggest that: (1) the redirection of the RF currents due to repositioning the PD has little impact on lesion size and only affects baseline impedance, and (2) the differences in lesion size are only 0.5 mm wider and 0.2 mm deeper for the anterior position, which does not seem to have a clinical impact in the context of VT ablation.

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Catheter ablation of ventricular tachycardia in patients with electrical storm, with a special focus on patients with Chagas disease

Cited by 3 publications

References 18 publications

Catheter Ablation in Arrhythmic Cardiac Diseases: Endocardial and Epicardial Ablation

Catheter Ablation in Arrhythmic Cardiac Diseases: Endocardial and Epicardial Ablation

Advanced management of ventricular arrhythmias in chronic Chagas cardiomyopathy

Effect of dispersive electrode position (anterior vs. posterior) in epicardial radiofrequency ablation of ventricular wall: A computer simulation study

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