Left ventricular summit ablation through open sternotomy with hybrid utilization of standard electrophysiology catheters and maneuvers

Sriramoju, Anil; Minaskeian, Nareg; Srivathsan, Komandoor; Sell-Dottin, Kristen; Shen, Win‐Kuang

doi:10.1016/j.hrcr.2021.09.011

Cited by 2 publications

(1 citation statement)

References 14 publications

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“…Although surgical ablation is uncommon, it may be considered in life‐threatening LVS‐VAs, including totally endoscopic robotic epicardial ablation (40–50 W, temperature < 42°C) and ablation through open sternotomy using a radiofrequency catheter, cryoablation catheter or direct myocardial ethanol injection 48,49 . Compared with endocardial and epicardial access, open sternotomy provides a clear view of the anatomic structure of the LVS and relatively stable catheter manipulation.…”

Section: Surgical Ablationmentioning

confidence: 99%

Mapping and ablation of ventricular arrhythmias arising from the left ventricular summit

Zhou,

Zheng,

et al. 2024

Pacing Clinical Electrophis

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The left ventricular summit (LVS) refers to the highest portion of the left ventricular outflow tract (LVOT). It is an epicardially delimited triangular area by the left coronary arteries and the coronary venous circulation. Its deep myocardium correlates closely with the left coronary cusp, aortic‐mitral continuity, and right ventricular outflow tract (RVOT), complicating the anatomical relationship. Ventricular arrhythmias (VAs) originating from this area are common, accounting for 14.5% of all VAs origin from left ventricle. Specific electrocardiogram (ECG) characteristics may assist in locating LVS‐VAs pre‐procedure and facilitate procedure planning. However, catheter ablation of LVS‐VAs remains challenging because of anatomical constraints. This paper reviews the recent understanding of LVS anatomy, concludes ECG characteristics, and summarizes current mapping and ablation methods for LVS‐VAs.

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Section: Surgical Ablationmentioning

confidence: 99%

Mapping and ablation of ventricular arrhythmias arising from the left ventricular summit

Zhou,

Zheng,

et al. 2024

Pacing Clinical Electrophis

View full text Add to dashboard Cite

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Surgery for ventricular tachycardia originating from the left ventricular summit

Nitta,

Sakamoto,

Murata

et al. 2023

European Journal of Cardio-Thoracic Surgery

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Background Ventricular tachycardia originating from the left ventricular summit region, the most superior region of the left ventricle surrounded by the major coronary arteries and veins, is frequently refractory to pharmacological therapies and endocardial and epicardial catheter ablation. Methods Eleven patients with an age from 31 to 79 (median 56) years old, underwent map-guided surgery for left ventricular summit ventricular tachycardia. All patients had undergone one to 5 unsuccessful sessions of catheter ablation for incessant ventricular tachycardia, preoperatively. Five patients had suffered ventricular tachycardia storm and 1 had a history of cardiopulmonary resuscitation. Four patients had implanted with a defibrillator. Epicardium to endocardium transmural cryothermia was applied at the ventricular tachycardia origin determined by intraoperative epicardial mapping with electro-anatomical mapping system. Harmonic scalpel was used to remove the epicardial fat and cryothermia was applied directly to the myocardium, avoiding thermal or mechanical injuries to the coronary vessels. Additional endocardial cryothermia at the ventricular tachycardia origin was performed by a cryoprobe introduced into the left ventricular cavity through an aortotomy. Results There was no surgical mortality or long-term mortality related to ventricular tachycardia during a median follow-up period of 60 months (IQR: 34–82). Five-year freedom from preoperatively documented left ventricular summit ventricular tachycardia and non-documented ventricular tachycardia was 91% and 73%, respectively. All the patients with postoperative ventricular tachycardia underwent successful catheter ablation. Other patients were free from ventricular tachycardia during the follow-up period. Conclusions Epicardial to endocardial transmural cryothermia at the ventricular tachycardia origin guided by intraoperative electro-anatomical mapping with a close collaboration with electrophysiologists was crucial in successful surgery for left ventricular summit ventricular tachycardia.

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Left ventricular summit ablation through open sternotomy with hybrid utilization of standard electrophysiology catheters and maneuvers

Cited by 2 publications

References 14 publications

Mapping and ablation of ventricular arrhythmias arising from the left ventricular summit

Mapping and ablation of ventricular arrhythmias arising from the left ventricular summit

Surgery for ventricular tachycardia originating from the left ventricular summit

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