Ablation of Stable VTs Versus Substrate Ablation in Ischemic Cardiomyopathy

Biase, Luigi Di; Burkhardt, J. David; Lakkireddy, Dhanunjaya; Carbucicchio, Corrado; Mohanty, Sanghamitra; Mohanty, Prasant; Trivedi, Chintan; Santangeli, Pasquale; Bai, Rong; Forleo, Giovanni B.; Horton, Rodney; Bailey, Shane; Sánchez, Javier; Al‐Ahmad, Amin; Hranitzky, Patrick; Gallinghouse, G. Joseph; Pelargonio, Gemma; Hongo, Richard; Beheiry, Salwa; Sheng, Hao; Reddy, Madhu; Rossillo, Antonio; Themistoclakis, Sakis; Russo, Antonio Dello; Casella, Michela; Tondo, Claudio; Natale, Andrea

doi:10.1016/j.jacc.2015.10.026

Cited by 285 publications

(123 citation statements)

References 25 publications

Supporting

Mentioning

117

Contrasting

Order By: Relevance

“…[26][27][28][29] However, this approach may have limited utility in patients with dilated cardiomyopathy, who often have a paucity of identifiable substrate (ie, small scars, few late potentials). 30 In these patients, the ablation approach is often limited to pace mapping or entrainment/activation mapping.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Ventricular Tachycardia Ablation Using Percutaneous Left Ventricular Assist Devices

Kusa

Miller

Whang

et al. 2017

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

All procedures were performed under general anesthesia with endotracheal intubation. Hemodynamic monitoring was performed using radial or femoral arterial blood pressure monitoring, and bilateral © 2017 American Heart Association, Inc. were all higher in the pLVAD group. During median follow-up of 215 days, the primary end point (recurrent VT, heart transplantation, or death) occurred in 36% of the pLVAD versus 26% of the non-pLVAD groups (P=0.14). After propensity matching for differences between groups, no differences were seen between groups for both acute procedural outcomes and the primary end point. Conclusions-In this large single-center scar-related VT ablation experience, despite the worse clinical status of the patients selected for pLVAD support, clinical outcomes were better than expected and were similar to healthier patients not receiving hemodynamic support. Patients with dilated cardiomyopathy presenting with electrical storm, advanced heart failure, and severe left ventricular dysfunction most frequently received hemodynamic support during VT ablation. (Circ Arrhythm Electrophysiol. 2017;10:e004717.

show abstract

Section: Discussionmentioning

confidence: 99%

Outcomes of Ventricular Tachycardia Ablation Using Percutaneous Left Ventricular Assist Devices

Kusa

Miller

Whang

et al. 2017

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

show abstract

“…16 Other studies that only targeted clinical VTs showed a similar prognosis. 17, 18 On the other hand, DS ablation showed as good prognosis as that of extensive substrate-based ablation 6 (16% and 19%, respectively, of the VT recurrence rate at the 2-year follow-up).…”

Section: Prophylactic Linear Ablationmentioning

confidence: 91%

Efficacy of Intensive Radiofrequency Energy Delivery to the Localized Dense Scar Area in Post-Infarction Ventricular Tachycardia Ablation　― A Comparative Study With Standard Strategy Targeting the Infarcted Border Zone ―

Kuroki

Nogami

Yoshida

et al. 2017

Circ J

View full text Add to dashboard Cite

investigating a new, less invasive ablation strategy in which as good a prognosis as that of whole-scar homogenization can be obtained. Mountantonakis et al showed how to identify channels of relatively higher voltage within the scar by adjusting the voltage limits of bipolar maps. 8 Tung et al demonstrated that targeting relatively earlier late potentials can expedite scar homogenization without the need for extensive ablation of all late potentials. 9 These strategies assess the characteristics within severely low voltage areas. Thus, we hypothesized that an ablation A lthough several substrate-guided ablation methods for ventricular tachycardia (VT) have been advocated, the long-term outcomes of these methods have been inadequate as a curable therapy. 1-5 Therefore, some extensive ablation strategies targeting late potentials or local abnormal ventricular activities using an epicardial approach have been developed, and relatively good outcomes have been reported. 6,7 However, these strategies often result in extensive ablation from both the endocardial and epicardial sides. Now, electrophysiologists are

show abstract

“…trategies for ablation of scar-based ventricular tachycardia (VT) include linear lesions through pace-or entrainment-mapped sites, 1 extensive ablation of late and abnormal potentials, [2][3][4] and core isolation of scar. 5 Ablation by these methods requires delivery of many focal lesions, typically in a linear pattern, resulting in long radiofrequency and procedural times.…”

mentioning

confidence: 99%

“…In the recently published VISTA trial (Ablation of Clinical Ventricular Tachycardia Versus Addition of Substrate Ablation on the Long Term Success Rate of VT Ablation) assessing the utility of substrate-based ablation for postinfarction VT, mean procedure and radiofrequency times were 4.2 hours and 68 minutes, respectively. 3 Radiofrequency ablation around scar borders to achieve core isolation has been demonstrated as a promising approach for the treatment of VT but is also associated with long procedure time (mean 5.4 hours) and a large number of individual radiofrequency applications (111 lesions). 5 Thus, tools to create contiguous linear radiofrequency lesions rapidly could significantly enhance these VT ablation strategies by significantly decreasing procedure and radiofrequency time.…”

mentioning

confidence: 99%

Feasibility of Rapid Linear-Endocardial and Epicardial Ventricular Ablation Using an Irrigated Multipolar Radiofrequency Ablation Catheter

Nazer

Walters

Duggirala

et al. 2017

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

Female farm swine (50-60 kg) were intubated and underwent general anesthesia with inhaled isoflurane 2% to 3%. Swine were randomly allocated to either linear or focal ablation. Each pig underwent both Original ArticleBackground-A common strategy for ablation of scar-based ventricular tachycardia is delivering multiple lesions in a linear pattern. Methods and Results-We tested the efficacy of a novel linear irrigated multipolar ablation catheter capable of creating linear lesions with a single application. Healthy swine underwent endocardial and epicardial linear ablation using a novel linear irrigated ablation catheter; control animals underwent focal lesions in a linear pattern over 3.5 cm with an irrigated radiofrequency catheter. The linear catheter contained 7 irrigated electrodes spaced over 3.5 cm and could deliver ≤25 W to each electrode. Linear ablation required significantly less radiofrequency time than focal ablation (56±11 versus 497±110 seconds; P<0.0001). At gross pathology, linear (n=18) epicardial lines were longer than focal (n=8) epicardial lines (3.3±0.7 versus 2.1±0.9 cm; P<0.0005), with greater volume (3.8±2.9 versus 1.5±1.6 cm 3 ; P=0.002). There was no difference between linear (n=22) and focal (n=7) endocardial line length or volume. Gaps (length 2.8±0.9 mm) were present in 53% of focal lines and 0% of linear ablation lines. No perforations, steam pops, or thrombus were noted. Conclusions-Compared with sequential focal radiofrequency ablation in a linear pattern, an irrigated multipolar linear ablation catheter safely delivers contiguous endocardial or epicardial lesions without gaps in a single ablation. This catheter shows promise for decreasing ventricular tachycardia ablation procedure time and improving outcome.

show abstract

Ablation of Stable VTs Versus Substrate Ablation in Ischemic Cardiomyopathy

Cited by 285 publications

References 25 publications

Outcomes of Ventricular Tachycardia Ablation Using Percutaneous Left Ventricular Assist Devices

Outcomes of Ventricular Tachycardia Ablation Using Percutaneous Left Ventricular Assist Devices

Efficacy of Intensive Radiofrequency Energy Delivery to the Localized Dense Scar Area in Post-Infarction Ventricular Tachycardia Ablation　― A Comparative Study With Standard Strategy Targeting the Infarcted Border Zone ―

Feasibility of Rapid Linear-Endocardial and Epicardial Ventricular Ablation Using an Irrigated Multipolar Radiofrequency Ablation Catheter

Contact Info

Product

Resources

About

Ablation of Stable VTs Versus Substrate Ablation in Ischemic Cardiomyopathy

Cited by 285 publications

References 25 publications

Outcomes of Ventricular Tachycardia Ablation Using Percutaneous Left Ventricular Assist Devices

Outcomes of Ventricular Tachycardia Ablation Using Percutaneous Left Ventricular Assist Devices

Efficacy of Intensive Radiofrequency Energy Delivery to the Localized Dense Scar Area in Post-Infarction Ventricular Tachycardia Ablation ― A Comparative Study With Standard Strategy Targeting the Infarcted Border Zone ―

Feasibility of Rapid Linear-Endocardial and Epicardial Ventricular Ablation Using an Irrigated Multipolar Radiofrequency Ablation Catheter

Contact Info

Product

Resources

About

Efficacy of Intensive Radiofrequency Energy Delivery to the Localized Dense Scar Area in Post-Infarction Ventricular Tachycardia Ablation　― A Comparative Study With Standard Strategy Targeting the Infarcted Border Zone ―