Catheter‐Based Cryoablation of Postinfarction and Idiopathic Ventricular Tachycardia: Initial Experience in a Selected Population

Timmermans, Carl; Manusama, Randy; Alzand, Becker S. N.; Rodriguez, Luz‐Maria

doi:10.1111/j.1540-8167.2009.01610.x

Cited by 12 publications

(4 citation statements)

References 13 publications

(22 reference statements)

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“…An alternative energy source is cryothermy, which has the advantage of being painless and not requiring conscious sedation [12,13]. Long-term follow-ups and larger sample sizes are still missing.…”

Section: General Considerationsmentioning

confidence: 99%

Ablation of Idiopathic Ventricular Tachycardia

Schreiber

Kottkamp

2010

Curr Cardiol Rep

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Idiopathic ventricular arrhythmias occur in patients without structural heart disease. They can arise from a variety of specific areas within both ventricles and in the supravalvular regions of the great arteries. Two main groups need to be differentiated: arrhythmias from the outflow tract (OT) region and idiopathic left ventricular, so-called fascicular, tachycardias (ILVTs). OT tachycardia typically originates in the right ventricular OT, but may also occur in the left ventricular OT, particularly in the sinuses of Valsalva or the anterior epicardium or the great cardiac vein. Activation mapping or pace mapping for the OT regions and mapping of diastolic potentials in ILVTs are the mapping techniques that are typically used. The ablation of idiopathic ventricular arrhythmias is highly successful, associated with only rare complications. Newly recognized entities of idiopathic ventricular tachycardias are those originating in the papillary muscles and in the atrioventricular annular regions.

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Section: General Considerationsmentioning

confidence: 99%

Ablation of Idiopathic Ventricular Tachycardia

Schreiber

Kottkamp

2010

Curr Cardiol Rep

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“…When applied percutaneously, cryothermal energy produces a more discrete lesion with less collateral damage to adjacent structures as compared to radiofrequency energy. Percutaneous cryoablation of VT associated with postinfarction ischemic cardiomyopathy has proved effective and safe, although a higher recurrence rate may be encountered, probably related to the smaller lesion size [73] . Ethanol injection in a coronary artery branch was proposed more than two decades ago to produce a controlled necrosis of the ventricular myocardium where the VT originates.…”

Section: Alternative Energy Sourcesmentioning

confidence: 99%

Role of catheter ablation of ventricular tachycardia associated with structural heart disease

Ponti

2011

WJC

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In patients with structural heart disease, ventricular tachycardia (VT) worsens the clinical condition and may severely affect the short-and long-term prognosis. Several therapeutic options can be considered for the management of this arrhythmia. Among others, catheter ablation, a closed-chest therapy, can prevent arrhythmia recurrences by abolishing the arrhythmogenic substrate. Over the last two decades, different techniques have been developed for an effective approach to both tolerated and untolerated VTs. The clinical outcome of patients undergoing ablation has been evaluated in multiple studies. This editorial gives an overview of the role, methodology, clinical outcome and innovative approaches in catheter ablation of VT. De Ponti R. Role of catheter ablation of ventricular tachycardia associated with structural heart disease.

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“…4–9 Several approaches have been developed to overcome this, such as the use of long-duration, half-normal saline irrigation, and bipolar approaches to radiofrequency ablation, in addition to using other energy sources such as cryoablation, radioablation, and alcohol ablation. 10–16…”

mentioning

confidence: 99%

“…[4][5][6][7][8][9] Several approaches have been developed to overcome this, such as the use of long-duration, half-normal saline irrigation, and bipolar approaches to radiofrequency ablation, in addition to using other energy sources such as cryoablation, radioablation, and alcohol ablation. [10][11][12][13][14][15][16] Pulsed field ablation (PFA) has recently been recognized for its potential to improve both the efficacy and safety of atrial ablation procedures. [17][18][19][20] Its nonthermal basis of ablation, reduced reliance on prolonged high-quality contact, and short delivery times also make it relevant for ventricular ablation, and early preclinical studies have been promising.…”

mentioning

confidence: 99%

Preclinical Study of Pulsed Field Ablation of Difficult Ventricular Targets: Intracavitary Mobile Structures, Interventricular Septum, and Left Ventricular Free Wall

Nies,

Watanabe,

Kawamura

et al. 2024

Circ: Arrhythmia and Electrophysiology

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Background: - Endocardial catheter-based pulsed field ablation (PFA) of the ventricular myocardium is promising. However, little is known about PFA's ability to target intracavitary structures, epicardium, and ways to achieve transmural lesions across thick ventricular tissue. Methods: - A lattice-tip catheter was used to deliver biphasic monopolar PFA to swine ventricles under general anesthesia, with electroanatomical mapping, fluoroscopy and intracardiac echocardiography (ICE) guidance. We conducted experiments to assess the feasibility and safety of repetitive monopolar PFA applications to ablate: i) intracavitary papillary muscles and moderator bands, ii) epicardial targets, and iii) bipolar PFA for midmyocardial targets in the interventricular septum and left ventricular (LV) free wall. Results: - i) Papillary muscles (n=13) were successfully ablated and then evaluated at 2, 7 and 21 days. Nine lesions with stable contact measured 18.3≥2.4 mm long, 15.3≥1.5 mm wide, and 5.8≥1.0 mm deep at 2 days. Chronic lesions demonstrated preserved chordae without mitral regurgitation. Two targeted moderator bands were transmurally ablated without structural disruption. ii) Transatrial saline/carbon dioxide assisted epicardial access was obtained successfully and epicardial monopolar lesions had a mean length, width, and depth of 30.4≥4.2 mm, 23.5≥4.1 mm, and 9.1≥1.9 mm, respectively. iii) Bipolar PFA lesions were delivered across the septum (n=11) and the LV free wall (n=7). Twelve completed bipolar lesions had a mean length, width, and depth of 29.6≥5.5 mm, 21.0≥7.3 mm, and 14.3≥4.7 mm, respectively. Chronically, these lesions demonstrated uniform fibrotic changes without tissue disruption. Bipolar lesions were significantly deeper than the monopolar epicardial lesions. Conclusions: - This in vivo evaluation demonstrates that PFA can successfully ablate intracavitary structures, create deep epicardial lesions and transmural LV lesions.

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Catheter‐Based Cryoablation of Postinfarction and Idiopathic Ventricular Tachycardia: Initial Experience in a Selected Population

Abstract: In this small patient population, catheter-based cryoablation of VT was safe and effective. Future studies are needed to evaluate the effect of cryothermy in a larger group of patients, especially those with postinfarction VT.

Cited by 12 publications

References 13 publications

Ablation of Idiopathic Ventricular Tachycardia

Ablation of Idiopathic Ventricular Tachycardia

Role of catheter ablation of ventricular tachycardia associated with structural heart disease

Preclinical Study of Pulsed Field Ablation of Difficult Ventricular Targets: Intracavitary Mobile Structures, Interventricular Septum, and Left Ventricular Free Wall

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