Impact of Intramural Scar on Mapping and Ablation of Premature Ventricular Complexes

Ghannam, Michael; Liang, Jackson J.; Dabbagh, Ghaith Sharaf; Siontis, Konstantinos C.; Attili, Anil; Cochet, Hubert; Jaı̈s, Pierre; Juhoor, Mehdi; Latchamsetty, Rakesh; Jongnarangsin, Krit; Morady, Fred; Bogun, Frank

doi:10.1016/j.jacep.2020.11.004

Cited by 5 publications

(5 citation statements)

References 19 publications

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“…Finally, PVCs were the most frequent ventricular arrhythmia targeted in this patient population with bicuspid aortic valves. The majority of the sites of origin were confined to the sinuses of Valsalva in close proximity to areas of LGE indicating that structural abnormalities often co‐localize with the sites of origin of PVCs 12 . This has been demonstrated by prior reports where the site of origin of PVCs was correlated with the location of LGE 13 …”

Section: Discussionmentioning

confidence: 66%

“…The majority of the sites of origin were confined to the sinuses of Valsalva in close proximity to areas of LGE indicating that structural abnormalities often co-localize with the sites of origin of PVCs. 12 This has been demonstrated by prior reports where the site of origin of PVCs was correlated with the location of LGE. 13 To our knowledge, this is the first series reporting on the safety of ablation near and within the aortic cusps in patients with native bicuspid valve disease.…”

Section: Ventricular Arrhythmias and Bicuspid Aortic Valvementioning

confidence: 58%

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Ventricular arrhythmias in patients with bicuspid aortic valves

Ghannam,

Kovacs,

Liang

et al. 2024

Cardiovasc electrophysiol

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IntroductionBicuspid aortic valves (BAV) are the most common congenital heart defects and the extent of ventricular arrhythmias (VA) in patients with BAV is unclear. The objective of this study is to describe VAs and late gadolinium enhancement cardiac magnetic resonance imaging (LGE‐CMR) in patients with BAV.MethodsA total of 19 patients with BAV (18 males, age: 58 ± 13 years) were referred for VA ablation procedures. Ten patients had BAVs at the time of ablation, nine patients had prior aortic valve replacement for a BAV. All but one patient had LGE‐CMR and all patients underwent programmed ventricular stimulation at the time of the ablation.ResultsFrequent PVCs were the targeted VAs in 17/19 patients and VT in 2/19 patients. Monomorphic ventricular tachycardia (VT) was inducible in 6 patients. A total of 15 VTs were inducible (2.5 ± 1.0 VTs per patient with a mean cycle length of 322 ± 83 msec). LGE was present in 13 patients. Patients with inducible VT had larger borderzone and core scar compared to non‐inducible patients (7.8 ± 2.1 cm3 vs. 2.5 ± 3.1 cm3 and 5.1 ± 2.6 cm3 vs. 1.9 ± 3.0 cm3, p‐value < .05 for both). PVCs and VTs were mapped to the periaortic valve area in 12 patients and 4 patients, respectively. The PVC burden was reduced from 27 ± 13 to 3 ± 6 (p < .001) and the ejection fraction improved from 49 ± 13% to 55 ± 9% (p = .005).ConclusionsVAs in patients with BAV often originate from the perivalvular area and patients often have LGE and inducible VT. LGE may be due to ventricular remodeling secondary to the presence of BAV and harbors the arrhythmogenic substrate for VT.

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Section: Discussionmentioning

confidence: 66%

Section: Ventricular Arrhythmias and Bicuspid Aortic Valvementioning

confidence: 58%

Ventricular arrhythmias in patients with bicuspid aortic valves

Ghannam,

Kovacs,

Liang

et al. 2024

Cardiovasc electrophysiol

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“…Detailed mapping of coronary venous system branches with multielectrode microcatheters to identify the true site of origin can facilitate more accurate targeting of OT‐VAs via anatomic approach, 3,4 and identification of the true site of origin can help pinpoint the optimal ablation trajectory to guide catheter placement during bipolar ablation. Lastly, preablation cardiac MRI can be helpful to identify areas of scar which may represent VA substrate that can be targeted with ablation 5 …”

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confidence: 99%

“…Lastly, preablation cardiac MRI can be helpful to identify areas of scar which may represent VA substrate that can be targeted with ablation. 5 While bipolar RFCA can be an effective bailout strategy for some patients with intramural OT-VAs refractory to standard…”

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confidence: 99%

Bipolar ablation for outflow tract ventricular arrhythmias: When the going gets tough, two catheters may be better than one

Huntrakul

Liang

2022

Cardiovasc electrophysiol

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Radiofrequency catheter ablation (RFCA) is an effective treatment strategy for patients with symptomatic ventricular arrhythmias (VAs).Conventional RFCA involves unipolar ablation in which the radiofrequency energy current is delivered between the catheter tip and a dispersive skin electrode. Ablation lesion size with unipolar ablation depends on multiple factors such as power, temperature, impedance, duration of energy delivery, and catheter-tissue contact force but is generally limited to 5-6 mm in depth. However, the substrate for VAs

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“…Lastly, pre-ablation cardiac MRI can be helpful to identify areas of scar which may represent VA substrate which can be targeted with ablation. 5 While bipolar RFCA can be an effective bailout strategy for some patients with intramural OT VAs refractory to standard sequential unipolar ablation, its general use still remains limited by potentially increased risk of complications as well as technical challenges including the requirement for specific cables and setup to visualize both catheters simultaneously on 3D mapping system and to deliver RF energy. With the current bipolar ablation systems, temperature at the catheter tip cannot be accurately monitored simultaneously for both catheters.…”

mentioning

confidence: 99%