Endocardial and epicardial radiofrequency ablation of ventricular tachycardia associated with dilated cardiomyopathy

Soejima, Kyoko; Stevenson, William G.; Sapp, John L.; Selwyn, Andrew P.; Couper, Gregory S.; Epstein, Laurence M.

doi:10.1016/j.jacc.2004.01.029

Cited by 455 publications

(318 citation statements)

References 23 publications

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“…Both endocardial or epicardial diseased substrates in NICM could exist and contain critical isthmuses for a successful ablation 53. These abnormal substrates frequently harbor fibrotic and scar tissue that lead to slow conduction and fractionated electrograms in human tissue experiments 54.…”

Section: Management Of Vt In Nicmmentioning

confidence: 99%

Ventricular arrhythmias in nonischemic cardiomyopathy

Chung

Lin

et al. 2018

Journal of Arrhythmia

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Nonischemic cardiomyopathies (NICMs) are composed of variable disease entities, including primary and secondary cardiomyopathies. Determining the etiology of NICM provides pivotal roles of not only the understanding of the individual pathogenesis, but also the clinical management, such as risk stratification, pharmacological treatment, and intervention therapies. Despite the diverse causes of NICM, these cases mostly require clinical attention owing to progressive myocardial injury, resulting in ventricular dysfunction and heart failure. The interaction between the diseased ventricular substrates and systemic/neurophysiological factors contributes to the cornerstones responsible for ventricular arrhythmogenesis and sudden cardiac death (SCD). Prevention of SCD and diminishing ventricular tachyarrhythmias are the important mainstays for the management of NICM patients. Given the understanding of the abnormal ventricular substrates and advancement of navigation systems, radiofrequency catheter ablation (RFCA) has become an adjunctive or alternative strategy for NICM patients who experience drug‐refractory ventricular tachycardias (VTs). Successful ablation can frequently be achieved at the expense of an epicardial intervention. A recent study has proven the survival benefits for NICM patients who are free from recurrent VTs after a successful RFCA, regardless of the New York Heart Association (NYHA) functional class status or left ventricular ejection fraction. Additionally, recent evidence has highlighted the better delineation of a diseased myocardium through the incorporation of cardiovascular magnetic resonance imaging (CMRI) and 3D mapping systems, which can facilitate the identification of critical ventricular arrhythmogenic substrates in NICM patients.

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Section: Management Of Vt In Nicmmentioning

confidence: 99%

Ventricular arrhythmias in nonischemic cardiomyopathy

Chung

Lin

et al. 2018

Journal of Arrhythmia

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“…NIDCM is known to have increased risk of VT, the substrate of monomorphic VT in NIDCM often exists in the deep endocardium 2 or adjacent to a valve annulus on both the epicardium and endocardium. [1][2][3][4] Haqqani et al reported that the isolated septal substrate in patients with NIDCM was rare and only 11.6% of these patients. 5 Although we tried to demonstrate the concealed entrainment at the initial strategy, the VT did not sustain long enough to perform such diagnostic maneuvers.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 The major substrates for VT in patients with NIDCM have been reported to be the basal periannular region of the left ventricle (LV). [1][2][3][4] On the other hand, isolated septal substrate is reported to be rare, and found in only 10% of these patients. 5 In addition, the treatment of VT associated with the septal substrate is challenging because the scar area exists entirely intramural zone or there are multiple VT circuits.…”

Section: Introductionmentioning

confidence: 99%

Unique preferential conduction within the isolated septal substrate in a patient with ventricular tachycardia complicated with non-ischemic dilated cardiomyopathy

Watanabe

Yokoshiki

Makino

et al. 2013

Journal of Electrocardiology

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We describe the case of a 67-year-old woman with non-ischemic dilated cardiomyopathy who underwent successful radiofrequency catheter ablation for ventricular tachycardia (VT) originated from the isolated ventricular septal substrate.Pacemapping exhibited either left, identical to clinical VT, or right bundle branch block like wide QRS morphology. Time interval from the stimulus to QRS onset (St-QRS) was prolonged at the center of the substrate, while St-QRS at the border was shortened. Difference in the morphology of pacemapping was dependent on whether or not the pacing stimulus could propagate directly into the right ventricle due to the possible intramural conduction disturbance.

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“…Magnetic resonance imaging with delayed gadolinium-enhancement and voltage mapping demonstrates that scars are often located adjacent to a valve annulus [36,37]. These features likely account for the general perception that patients present with multiple morphologies of VT, and ablation is more difficult than that in the remote MI-VT population.…”

Section: Non-ischemic Dilated Cardiomyopathymentioning

confidence: 99%

Long‐term outcomes of catheter ablation of ventricular tachycardia in patients with structural heart disease

Goya

Fukunaga

Hiroshima

et al. 2014

Journal of Arrhythmia

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a b s t r a c tBackground: Catheter ablation of ventricular tachycardia (VT) is feasible. However, the long-term outcomes for different underlying diseases have not been well defined. Methods: Eighty-eight consecutive patients who underwent catheter ablation of VT using a threedimensional mapping system were analyzed. The primary endpoint was any VT or ventricular fibrillation (VF) recurrence. Secondary endpoints were a composite of death or any VT/VF recurrence. Underlying heart diseases were remote myocardial infarction (remote MI) in 51 patients and non-ischemic cardiomyopathy in 37 (arrhythmogenic right ventricular cardiomyopathy [ARVC] in 18 patients, and dilated cardiomyopathy [NIDCM] in 19). Results: Acute success was achieved in 82 of 88 (93%) patients. During a follow-up period of 39.2 74.6 months, VT recurred in 26 of 87 (30%), and VT/VF recurrence or death occurred in 39 of 87 (45%) patients. ARVC had better outcomes than NIDCM for the primary (p o 0.05) and secondary endpoints (po 0.05). Remote MI-VT revealed a midrange outcome. Conclusions: The long-term outcomes after catheter ablation of VT varied according to the underlying heart disease. ARVC-VT ablation was associated with better long-term prognosis than NIDCM. Remote MI-VT demonstrated a midrange outcome.

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Endocardial and epicardial radiofrequency ablation of ventricular tachycardia associated with dilated cardiomyopathy

Cited by 455 publications

References 23 publications

Ventricular arrhythmias in nonischemic cardiomyopathy

Ventricular arrhythmias in nonischemic cardiomyopathy

Unique preferential conduction within the isolated septal substrate in a patient with ventricular tachycardia complicated with non-ischemic dilated cardiomyopathy

Long‐term outcomes of catheter ablation of ventricular tachycardia in patients with structural heart disease

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