Ablation of ventricular tachycardia from the aortic root after transcatheter aortic valve replacement

Srivatsa, Uma N.; Nordsieck, Eric; Pezeshkian, Nayereh G; Yang, Yingbo; Southard, Jeffrey

doi:10.1016/j.hrcr.2017.12.009

Cited by 6 publications

(18 citation statements)

References 10 publications

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“…40,41 Therefore smaller curve catheters would be predicted to cross bioprosthetic valves more readily. Despite reports of supravalvular mapping and ablation in patients with transaortic valve replacement, 42 crossing of the prosthetic valve via the retrograde route has not been reported in these patients and is not recommended.…”

Section: Replacement Aortic Valvesmentioning

confidence: 99%

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: Replacement Aortic Valvesmentioning

confidence: 99%

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

Adlan

Campbell

Fairbairn

et al. 2019

Cardiovasc electrophysiol

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“…[1] Conduction abnormalities and need for pacemaker implantation following TAVR implantation are widely recognized complications. [2,3] Postprocedural ventricular arrythmias (VA), however, have rarely been reported. [2] There remains a signi cant paucity of data on the incidence and prognostic signi cance of these tachyarrhythmias.…”

Section: Introductionmentioning

confidence: 99%

“…[2,3] Postprocedural ventricular arrythmias (VA), however, have rarely been reported. [2] There remains a signi cant paucity of data on the incidence and prognostic signi cance of these tachyarrhythmias. [1] We present two cases of focal out ow tract ventricular tachycardia, one occurring early and the other late post transcatheter aortic valve implantation.…”

Section: Introductionmentioning

confidence: 99%

Iatrogenic Left Ventricle Outflow Tract Ventricular Tachycardia Following Transcatheter Aortic Valve Replacement: A Case Series

Qavi

Naniwadekar

Shah

2023

Preprint

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Background: Focal left ventricular outflow tract ventricular tachycardia (LVOT-VT) has been rarely reported following transcatheter aortic valve replacement (TAVR). Case Presentation: Our first case is a 70-year-old man with bicuspid aortic valve (Sievers type 0) who was found to have severe aortic valve stenosis and underwent uncomplicated transfemoral TAVR with 26-mm Edwards SAPIEN-3 Ultra valve. Five months later, he presented to emergency room with dizziness and dyspnea. ECG suggested VT of LVOT origin. Cardiac MRI revealed no fibrosis. Patient was treated with amiodarone with suppression of VT. Our second case is of an 80-year-old man who was diagnosed with symptomatic severe aortic stenosis. He also underwent transfemoral TAVR with 26-mm Edwards SAPIEN-3 Ultra valve. He had complete heart block postoperatively, necessitating a pacemaker. Twelve hours later, he suffered sustained VT of one hour duration, morphology suggestive of LVOT on ECG. Coronary angiography showed patent coronary arteries. He was also managed with amiodarone with suppression of VT. Conclusions: LVOT-VT following TAVR may be secondary to disease process affecting the valve and adjacent area, direct mechanical pressure of valve stent against LVOT, change in LVOT geometry, periaortic scar or yet unknown mechanism from an unrelated substrate. Unexplained sudden cardiac death after TAVR may be attributable to VT; hence it is important to be aware of this rare association.

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“…Transcatheter aortic valve replacements (TAVRs) are a minimally invasive procedure and have been increasingly performed in high‐risk patients with severe aortic stenosis that are not candidates for open‐heart surgery . Focal LVOT VAs also can occur after a TAVR, and RFCA should be considered as a treatment option when those VAs are drug‐refractory . However, there should be specific challenges in the RFCA of LVOT VAs after a TAVR because the tubular structure of the TAVR device sits in the LVOT.…”

Section: Introductionmentioning

confidence: 99%

“…3 Focal LVOT VAs also can occur after a TAVR, and RFCA should be considered as a treatment option when those VAs are drug-refractory. [4][5][6] However, there should be specific challenges in the RFCA of LVOT VAs after a TAVR because the tubular structure of the TAVR device sits in the LVOT. This article describes those challenges and practical approach of mapping and ablation of LVOT VAs in patients with a TAVR.…”

Section: Introductionmentioning

confidence: 99%

Special considerations in mapping and ablation of focal ventricular arrhythmias originating from the left ventricular outflow tract in patients with a transcatheter aortic valve replacement

Yamada

2019

Cardiovasc electrophysiol

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Transcatheter aortic valve replacements (TAVRs) have been increasingly performed in high‐risk patients with severe aortic stenosis. Focal ventricular arrhythmias (VAs) originating from the left ventricular outflow tract (LVOT) can occur after a TAVR, and radiofrequency catheter ablation (RFCA) should be considered as a treatment option when those VAs are drug‐refractory. There are specific challenges in the RFCA of LVOT VAs after a TAVR because the tubular structure of the TAVR device sits in the LVOT. However, if the anatomical background of the TAVR and LVOT VAs are well understood and the anatomical relationship between the TAVR device and LVOT is sufficiently evaluated, RFCA of LVOT VAs in patients with a TAVR should be safe and highly successful.

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Ablation of ventricular tachycardia from the aortic root after transcatheter aortic valve replacement

Cited by 6 publications

References 10 publications

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

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

Iatrogenic Left Ventricle Outflow Tract Ventricular Tachycardia Following Transcatheter Aortic Valve Replacement: A Case Series

Special considerations in mapping and ablation of focal ventricular arrhythmias originating from the left ventricular outflow tract in patients with a transcatheter aortic valve replacement

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