Epicardial Mapping and Ablation in Management of Ventricular Tachycardia

Simonova, K. A.; Лебедев, Д. С.; Mikhaylov, Evgeny N.

doi:10.17802/2306-1278-2017-6-4-138-145

Cited by 5 publications

(3 citation statements)

References 6 publications

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“…У пациентов с АКПЖ и желудочковыми нарушениями ритма наиболее часто ЗИЭА располагаются на эпикардиальной поверхности и недоступны картированию с эндокардиальной поверхности [8]. При эндокардиальном картировании ЖТ целесообразно сопоставлять площадь регистрации ЗИЭА на би-и униполярной картах для оценки выраженности субэпикардиального поражения миокарда и прогнозирования эффективности эндокардиальной аблации, планирования эпикардиального доступа.…”

Section: обсуждение полученных результатовunclassified

Endocardial and endo-epicardial substrate mapping and ablation of ventricular arrhythmia in patients with arrhythmogenic right ventricular cardiomyopathy

Simonova

Каменев

Tatarskiy

et al. 2020

Vestnik aritmologii

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Purpose: to compare epicardial and endocardial surface area of local abnormal ventricular activity (LAVA) and low voltage zone (LVZ) and effectiveness of endocardial versus combined endo-epicardial ablation of ventricular arrhythmias in ARVC patients.Methods: a prospective observational “case-control” study comprised 20 patients with ARVC and ventricular arrhythmias referred to catheter ablation. The study group with epicardial approach (EPI group) comprised 10 patients with sustained VT, who signed informed consent for the epicardial access. The control group (ENDO group) comprised 10 patients with sustained VT or frequent symptomatic premature ventricular contractions (PVC). Electroanatomical voltage mapping and LAVA ablation was performed.Results: the patient mean age was 41.4±13.8 years, 70% males; 90% patients in the EPI group had sustained VT, 50% - in the ENDO group. In the EPI group the endocardial unipolar low voltage zone area (LVZ) significantly prevailed over the bipolar endocardial LVZ area: 75.4 cm2 [IQR: 23.2; 211.9] vs 6.7 cm2 [IQR: 4.4; 35.5] (Р=0.009). In the ENDO group the LVZ area on unipolar map had a trend toward the prevalence over the bipolar area, but was not statistically different: 12.7 cm2 (IQR: 0; 46.3) vs 3.65 cm2 (IQR: 0; 46.3) (Р>0.05). The epicardial bipolar LVZ area prevailed over unipolar epicardial LVZ area: 65.3 cm2 [IQR: 55.6; 91.3] vs 6.7 cm2 [IQR: 4.4; 35.3] (Р=0.005). Non-inducibility of any ventricular arrhythmia was achieved in 90% of EPI patients and in 80% of ENDO cases. The median follow-up period was 22.3±10.5 months. During a mean follow-up period freedom of ventricular arrhythmia recurrence was 70% in the EPI group and 100% in the control group (Р>0.05).Conclusion: Although there was a significant difference in bipolar LVZ areas between endo- and epicardial maps, our series showed that endocardial only ablation is an effective strategy in ventricular arrhythmia management in ARVC patients.

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Section: обсуждение полученных результатовunclassified

Endocardial and endo-epicardial substrate mapping and ablation of ventricular arrhythmia in patients with arrhythmogenic right ventricular cardiomyopathy

Simonova

Каменев

Tatarskiy

et al. 2020

Vestnik aritmologii

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“…Кардіальна магнітно-резонансна томографія (МРТ) із контрастним посиленням гадолінієм дає можливість прижиттєво виявити вогнищевий або дифузний ФМ [47], але це дослідження є малодоступним у практичній медицині [39,53]. МРТ можна використовувати для визначення аритмогенного субстрату [24,32].…”

Section: Reviewunclassified

Electrical myocardial instability as a problem of modern therapeutic practice – the realities of prognosis (a literature review)

Іванов

Shushkovska

Afanasiuk

et al. 2020

ZMJ

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“…Most frequently, epicardial ablation is required for VT treatment in non-ischemic heart disease, when substrate is characterized by intramural or subepicardial location: arrhythmogenic right ventricle cardiomyopathy, dila ted cardiomyopathy, hypertrophic cardiomyopathy (HCM), and other [12].…”

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Epicardial voltage mapping in patients with postinfarction ventricular tachycardia: a pilot study

Simonova

Mikhaylov

Tatarskiy

et al. 2020

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Introduction. Radiofrequency ablation (RFA) is an established treatment of post-myocardial infarction ventricular tachycardia (VT). Endocardial VT ablation can be insufficient for VT termination when the scar is intramural/epicardial.Purpose: to assess the extent of epicardial electrophysiological VT substrate in patients with remote myocardial infarction.Materials and methods. Thirteen patients with sustained postinfarction VT, who signed an informed consent, were included into the study. All patients underwent full clinical evaluation. Electroanatomical voltage bi- and unipolar mapping of endocardial and epicardial surfaces was performed. Maps were evaluated for the presence of low-voltage areas and local abnormal ventricular activity (LAVA). RFA was performed at LAVA sites. The end-point of the procedure was scar LAVA abolition and VT noninducibility (procedure success). VT recurrence was detected using an implantable cardioverter-defibrillator and/or ECG monitoring.Results. Epicardial access was successful in 12 patients. Epicardial access was performed at a first procedure in 7 patients, 4 patients had a history of previous endocardial ablation. Epicardial LAVA sites were detected in 9 patients. Endocardial and epicardial arrhythmogenic substrate localization coincided in 8 patients. One patient had only epicardial scar, 1 patient had only septal endocardial scar. In one patient LAVA sites had different localizations on epicardial and endocardial maps. Acute ablation success was noted in 12 patients.Conclusion. In our patient group transmural scar and epicardial electrophysiological arrhythmogenic substrate was detected in 82% of cases. Isolated endocardial ablation may be unsuccessful, in such cases epicardial mapping and ablation might be useful.

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Epicardial Mapping and Ablation in Management of Ventricular Tachycardia

Cited by 5 publications

References 6 publications

Endocardial and endo-epicardial substrate mapping and ablation of ventricular arrhythmia in patients with arrhythmogenic right ventricular cardiomyopathy

Endocardial and endo-epicardial substrate mapping and ablation of ventricular arrhythmia in patients with arrhythmogenic right ventricular cardiomyopathy

Electrical myocardial instability as a problem of modern therapeutic practice – the realities of prognosis (a literature review)

Epicardial voltage mapping in patients with postinfarction ventricular tachycardia: a pilot study

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