EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: Developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA)

Aliot, Étienne; Stevenson, William G.; Almendral-Garrote, Jesus Ma; Bogun, Frank; Calkins, C. Hugh; Delacrétaz, Etienne; Bella, Paolo Della; Hindricks, Gerhard; Jaı̈s, Pierre; Josephson, Mark E.; Kautzner, Josef; Kay, G. Neal; Kuck, Karl Heinz; Lerman, Bruce B.; Marchlinski, Francis E.; Reddy, Vivek Y.; Schalij, Martin J.; Schilling, Richard J.; Soejima, Kyoko; Wilber, David J.

doi:10.1093/europace/eup098

Cited by 456 publications

(434 citation statements)

References 445 publications

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“…Both VTs are verapamil-sensitive, and ablation of the diastolic potential representing the Purkinje potential has been effective in eliminating the VTs [3][4][5][6][7][8] . In the present case report, a patient with recurrent syncope and palpitation demonstrated pleomorphic VTs 9 originating from the Purkinje fiber network of left anterior fascicle, in which the critical diastolic potentials and delayed potentials were identified during the VTs and sinus rhythm.…”

Section: Introductionmentioning

confidence: 63%

Pleomorphic ventricular tachycardia originating from Purkinje fiber network of left anterior fascicle

Yokoshiki

Makino

Watanabe

et al. 2010

Journal of Electrocardiology

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A 55-year old woman with recurrent syncope and palpitation experienced polymorphic ventricular tachycardia (VT) and more than three monomorphic VTs with a right bundle branch block configuration, either inferior-, middle-, and superior-axis.During the pleomorphic VT, the diastolic potential (dp) was recorded at the antero-lateral left ventricle. Changes in the QRS morphology were associated with the time between dp and onset of QRS complex (dp-V interval), and prolongation of dp-V interval terminated the VT. In addition, the delayed potentials were seen during sinus rhythm around this area. Delivery of radiofrequency current targeting the delayed potentials abolished all the VTs. Different exits from relatively large area of slow conduction in the left anterior fascicle might have produced the pleomorphic VTs.

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Section: Introductionmentioning

confidence: 63%

Pleomorphic ventricular tachycardia originating from Purkinje fiber network of left anterior fascicle

Yokoshiki

Makino

Watanabe

et al. 2010

Journal of Electrocardiology

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“…To assess the morphological characteristics of 12-lead ECG, the first QRS complex during VT was analyzed. The diagnosis of polymorphic VT was based on the European Heart Rhythm Association / Heart Rhythm Society Expert Consensus [9], which defines it as a continuously changing QRS configuration from beat to beat.…”

Section: Ecg Analysismentioning

confidence: 99%

Characteristics of idiopathic ventricular tachycardia originating above the pulmonary valve

et al. 2015

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AbstractsPanoptic studies of ventricular tachycardia (VT) originating above the pulmonary valve are scarce. The purpose of this study is to clarify the characteristic of idiopathic VT arising above pulmonary valve. We analyzed 15 consecutive patients with idiopathic VT that was successfully abolished by catheter ablation at the right ventricular outflow tract (RVOT-VT, n = 11) and above the pulmonary valve (PA-VT, n = 4). Incidence of syncope was higher in PA-VT than RVOT-VT (100 % vs 27 %, P < 0.05) and polymorphic VT was also more prevalent in PA-VT (75 % vs 0 %, P < 0.05). The coupling interval (315 ± 29 ms vs 449 ± 32 ms, mean ± SE) at the onset of VT and minimum cycle length (CL) (192 ± 13 ms vs 344 ± 37 ms) during VT were shorter in PA-VT (both P < 0.05). Among 12-lead ECG parameters, only R-wave amplitude in lead II was different between groups (2.05 ± 0.17 mV in PA-VT vs 1.44 ± 0.05 mV in RVOT-VT, P < 0.005). At the successful ablation site, the activation time from the onset of QRS complex did not differ between groups ( -37 ± 3 ms vs -31 ± 4 ms, P = 0.405), whereas the amplitude of intracardiac electrograms was significantly lower in PA-VT (0.83 ± 0.38 mV vs 2.39 ± 0.36 mV, P < 0.05). Although the number of patients in this study is limited, VT originating above the pulmonary valve demonstrated rapid excitation and often degenerated into polymorphic VT, suggesting its malignant electrophysiological characteristics.

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“…Of them, the subxiphoid approach is the safest without the use of ultrasound guidance [5]. Although the subxiphoid approach including the anterior and posterior approaches has been reported [6], the anatomical assessment by using 3D-CT has not been well discussed.…”

Section: Main Findingsmentioning

confidence: 99%

Anatomical consideration for safe pericardiocentesis assessed by three‐dimensional computed tomography: Should an anterior or posterior approach be used?

Teranishi

Okajima

Kiuchi

et al. 2014

Journal of Arrhythmia

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a b s t r a c tBackground: The efficacy of epicardial catheter ablation for ventricular tachycardia has been reported. However, the safest anatomical method for pericardial puncture has not been determined. Methods: Thirty patients who underwent 3-dimensional computed tomography (3D-CT) preceding catheter ablations for atrial fibrillation were enrolled in this study. We used the skin surface 1 cm below the xiphisternum as the puncture site. For the anterior approach, the attainment site was the pericardium of the mid portion of right ventricular anterior site, and for the posterior approach it was the pericardium of the inferior ventricular site. The distance and the angle between the 2 sites were measured using 3D-CT. Results: For the anterior approach, the distance was 54711 mm and the needle angle was 377111 toward the left scapula and 347121 towards the back of the body. For the posterior approach, the distance was 56710 mm and the corresponding needle angles were 60791 and 867131. The distance correlated with BMI for the anterior and posterior approaches (anterior approach: r 2 ¼0.43, Po0.001; posterior approach: r 2 ¼0.49, Po0.001). Liver existed along the pathway of the posterior approach in 11 (37%) of 30 patients, and through in 2 (18%) of 11 patients. The liver and lung were not located along the pathway of the anterior approach in any patients. Conclusions: Performing subxiphoid pericardiocentesis is anatomically safer via the anterior approach than via the posterior approach.

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Cited by 456 publications

References 445 publications

Pleomorphic ventricular tachycardia originating from Purkinje fiber network of left anterior fascicle

Pleomorphic ventricular tachycardia originating from Purkinje fiber network of left anterior fascicle

Characteristics of idiopathic ventricular tachycardia originating above the pulmonary valve

Anatomical consideration for safe pericardiocentesis assessed by three‐dimensional computed tomography: Should an anterior or posterior approach be used?

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