Catheter Ablation of Ventricular Tachycardia as the First‐Line Therapy in Patients With Coronary Artery Disease and Preserved Left Ventricular Systolic Function: Long‐Term Results

Clemens, Marcell; Peichl, Petr; Wichterle, Dan; Pavlů, Luděk; Čihák, Robert; Aldhoon, Bashar; Kautzner, Josef

doi:10.1111/jce.12751

Cited by 11 publications

(7 citation statements)

References 23 publications

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“…Numerous studies have shown CA to be effective. 23 – 26 , 29 – 33 Patel et al 30 reported on a 262 patient study comparing CA to non-ablative strategies and found the rate of recurrent VT was lower in CA populations than in the non-CA cohort. Numerous other reports have demonstrated the efficacy and potential of CA as a first-line strategy for VT. 23 , 24 , 26 , 31 – 33 While promising, RF CA is not without issues.…”

Section: Discussionmentioning

confidence: 99%

“…CA is designed to alter cardiac tissue architecture, thereby preventing/correcting cardiac arrhythmias, including VT. 19 CA strategies have been shown to be effective treatment options. [22][23][24][25][26][27][28] CA is typically performed using radio frequency (RF) to burn cardiac tissue, destroying an arrhythmogenic foci to create a scar resulting in conduction block, thereby preventing propagation of the arrhythmia. Numerous studies have shown CA to be effective.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of a novel cryoablation device for the endovascular treatment of cardiac tachyarrhythmias

et al. 2018

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Objectives:Cryoablation is an effective alternative treatment for cardiac arrhythmias offering shortened recovery and reduced side effects. As the use of cryoablation increases, the need for new devices and procedures has emerged. This has been driven by technological limitations including lengthy periods to generate a single lesion (3–5 min), uncertain transmurality, and differential efficacy. Furthermore, due to limited ablation capacity under high heat loads, cryo has had limited success in the treatment of ventricular arrhythmias. To this end, in this study we evaluated a new cryoablation catheter, ICEolate, for the targeted ablation of cardiac tissue.Methods:Performance assessment included calorimetry, freeze zone isothermal distribution characterization and catheter ablation capacity in a submerged, circulating, heat-loaded ex vivo tissue model. A pilot in vivo study was also conducted to assess ablative capacity of the cryocatheter in a fully beating heart.Results:Ex vivo studies demonstrated ice formation at the tip of a cryocatheter within 5 s and a tip temperature of ~−150°C within 10 s. The device repeatedly generated freeze zones of 2 cm × 3 cm in less than 2 min. Tissue model studies revealed the generation of a full thickness (5–10 mm) cryogenic lesion within 1 min with an opposite (transmural) surface temperature of <−60°C under a circulating 37°C heat load. Pilot in vivo studies demonstrated the delivery of an ablative “dose,” producing a continuous full thickness transmural linear lesion in <60 s at both atrial and ventricular sites.Conclusion:These studies suggest that the supercritical nitrogen cryodevice and ICEolate cryocatheter may provide for rapid, effective, controllable freezing of targeted tissue. The ablative power, speed, and directional freeze characteristics also offer the potential of improved safety via a reduction in procedural time compared to current cryoablation devices. These technological developments may open new avenues for the application of cryo to treat other cardiac arrhythmogenic disorders.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Assessment of a novel cryoablation device for the endovascular treatment of cardiac tachyarrhythmias

et al. 2018

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“…Such patients were not well represented in pivotal clinical trials on the use of ICDs. Several smaller studies including our study with 31 patients who underwent CA and ICD was implanted in 42% for continuing inducibility of non-clinical VTs, suggested that primary CA may prevent recurrences of VT and that these patients have a low risk of SCD [14]. The collaborative study by Maury et al compared the outcome of 166 patients with different type of structural heart disease, left ventricular ejection fraction over 30% and well tolerated VT who underwent CA with 378 similar subjects with an ICD during the same period [15].…”

Section: Ventricular Tachycardia In Structural Heart Diseasementioning

confidence: 92%

Catheter ablation to prevent sudden cardiac death

Kautzner

Peichl

2017

International Journal of Cardiology

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“…For the first time, recommendations include catheter ablation as an alternative to ICD therapy in IHD patients with haemodynamically tolerated SMVT and preserved or mildly reduced left ventricular function 71 , 72 (class IIa), while the 2015 guidelines and other international guidelines 73 recommend ICD implantation in this scenario. Although the secondary preventive ICD trials did not show a survival benefit in patients with a left ventricular ejection fraction ≥35%, 74 ICDs are frequently implanted in this patient group.…”

Section: Introductionmentioning

confidence: 99%

“…Similar evolution of recommendations can be found regarding coronary artery disease. In this context, programmed electrical stimulation (PES) experiences a renaissance: Not only is the recommendation for PES in patients with unexplained syncope and previous myocardial infarction upgraded to class I, but the new guidelines also recommend ICD therapy in patients with LVEF ≤40% and documented NSVT in whom SMVT is inducible by PES (IIa) 71 , 72 and, for the first time, recommends ICD therapy in ARVC patients with moderate right or left ventricular dysfunction and either NSVT or inducible SMVT. 81–84 PES is also mentioned (class IIb recommendation) for risk stratification in asymptomatic patients with a spontaneous type 1 Brugada ECG.…”

Section: Introductionmentioning

confidence: 99%

Spotlight on the 2022 ESC guideline management of ventricular arrhythmias and prevention of sudden cardiac death: 10 novel key aspects

et al. 2023

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Sudden cardiac death and ventricular arrhythmias are a global health issue. Recently, a new guideline for the management of ventricular arrhythmias and prevention of sudden cardiac death has been published by the European Society of Cardiology that serves as an update to the 2015 guideline on this topic. This review focuses on 10 novel key aspects of the current guideline: As new aspects, public basic life support and access to defibrillators are guideline topics. Recommendations for the diagnostic evaluation of patients with ventricular arrhythmias are structured according to frequently encountered clinical scenarios. Management of electrical storm has become a new focus. In addition, genetic testing and cardiac magnetic resonance imaging significantly gained relevance for both diagnostic evaluation and risk stratification. New algorithms for antiarrhythmic drug therapy aim at improving safe drug use. The new recommendations reflect increasing relevance of catheter ablation of ventricular arrhythmias, especially in patients without structural heart disease or stable coronary artery disease with only mildly impaired ejection fraction and haemodynamically tolerated ventricular tachycardias. Regarding sudden cardiac death risk stratification, risk calculators for laminopathies, and long QT syndrome are now considered besides the already established risk calculator for hypertrophic cardiomyopathy. Generally, ‘new’ risk markers beyond left ventricular ejection fraction are increasingly considered for recommendations on primary preventive implantable cardioverter defibrillator therapy. Furthermore, new recommendations for diagnosis of Brugada syndrome and management of primary electrical disease have been included. With many comprehensive flowcharts and practical algorithms, the new guideline takes a step towards a user-oriented reference book.

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Catheter Ablation of Ventricular Tachycardia as the First‐Line Therapy in Patients With Coronary Artery Disease and Preserved Left Ventricular Systolic Function: Long‐Term Results

Cited by 11 publications

References 23 publications

Assessment of a novel cryoablation device for the endovascular treatment of cardiac tachyarrhythmias

Assessment of a novel cryoablation device for the endovascular treatment of cardiac tachyarrhythmias

Catheter ablation to prevent sudden cardiac death

Spotlight on the 2022 ESC guideline management of ventricular arrhythmias and prevention of sudden cardiac death: 10 novel key aspects

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