Long-Term Outcomes of Combined Epicardial and Endocardial Ablation of Monomorphic Ventricular  Tachycardia Related to Hypertrophic Cardiomyopathy

Dukkipati, Srinivas R.; d’Ávila, André; Soejima, Kyoko; Bala, Rupa; Inada, Keiichi; Singh, Sheldon M.; Stevenson, William G.; Marchlinski, Francis E.; Reddy, Vivek Y.

doi:10.1161/circep.110.957290

Cited by 138 publications

(82 citation statements)

References 24 publications

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“…The models considered two internally cooled catheter tip electrodes (7Fr diameter, 4 mm catheter tip), similar to those used in RF cardiac ablation [3,4,18,19]. Although open-irrigated catheters are commonly used for VFW ablation [6], they have been associated with problems of fluid accumulation in the epicardial space (due to saline irrigation) necessitating frequent aspirations before each lesion [20].…”

Section: Computer Modelingmentioning

confidence: 99%

“…We modeled an internally-cooled catheter, and although these catheters are used for clinical RF ablation of cardiac tissue [3,4,18,19], other types of catheters, such as non-irrigated and open-irrigated catheters, are also employed for this type of intervention. The conclusions reached in this study could therefore be different when using other catheter designs.…”

Section: Study Limitationsmentioning

confidence: 99%

“…However, the effects of different ventricular wall thicknesses and catheter alignment on the degree of transmurality and lesion geometry created have never been studied in detail. Although, BM and UM have previously been compared in the ventricular free wall (VFW) ablations [3][4][5], no information is available on their performance in an endocardium-epicardium approach.…”

Section: Introductionmentioning

confidence: 99%

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Radiofrequency cardiac ablation with catheters placed on opposing sides of the ventricular wall: Computer modelling comparing bipolar and unipolar modes

González-Suárez

Trujillo

Koruth³

et al. 2014

International Journal of Hyperthermia

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Koruth, J.; Berjano, E. (2014). Radiofrequency cardiac ablation with catheters placed on opposing sides of the ventricular wall: Computer modelling comparing bipolar and unipolar modes. International Journal of Hyperthermia. 30 (6) Materials and methods:We built computational models to study the temperature distributions and lesion dimensions created by BM and UM on IVS and VFW during RFA. Two different UM types were considered: sequential (SEUM) and simultaneous (SIUM). The effect of ventricular wall thickness, catheter misalignment, epicardial fat, and presence of air in the epicardial space were also studied.Results: As regards IVS ablation, BM created transmural and symmetrical lesions for wall thicknesses up to 15 mm. SEUM and SIUM were not able to create transmural lesions with IVS thicknesses ≥ 12.5 and 15 mm, respectively. Lesions were asymmetrical only with SEUM. For VFW ablation, BM also created transmural lesions for wall thicknesses up to 15 mm. However, with SEUM and SIUM transmurality was obtained for VFW thicknesses ≤ 7.5 and 12.5 mm, respectively. With the three modes VFW lesions were always asymmetrical. In the scenario with air or a fat tissue layer on the epicardial side, only SIUM was capable of creating transmural lesions. Overall, BM was superior to UM in IVS and VFW ablation when the catheters were not aligned. Conclusions:Our findings suggest that BM is more effective than UM in achieving transmurality across both ventricular sites, except in the situation of the epicardial catheter tip surrounded by air or placed over a fat tissue layer.

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Section: Computer Modelingmentioning

confidence: 99%

Section: Study Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Radiofrequency cardiac ablation with catheters placed on opposing sides of the ventricular wall: Computer modelling comparing bipolar and unipolar modes

González-Suárez

Trujillo

Koruth³

et al. 2014

International Journal of Hyperthermia

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“…6,7 The use of epicardial ablation as a preemptive and adjunctive strategy has been reported in multiple observational studies of DCM, ARVC, and HCM. [8][9][10][11][12] A combined epicardial-endocardial approach is associated with improved freedom from ventricular tachycardia (VT) recurrence when compared to more limited endocardial strategies. 13 In our experience, patients with ischemic cardiomyopathy also experience greater freedom from recurrence when epicardial ablation is performed in combination with endocardial ablation (Figure 2).…”

Section: Indications For Epicardial Mapping and Ablationmentioning

confidence: 99%

Epicardial Ablation of Ventricular Tachycardia

Tung

Shivkumar

2015

Methodist DeBakey Cardiovascular Journal

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Epicardial mapping and ablation via a percutaneous subxiphoid technique has been instrumental in improving the working understanding of complex myocardial scars in various arrhythmogenic substrates. Endocardial ablation alone may not be sufficient in patients with ischemic cardiomyopathy, dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, hypertrophic cardiomyopathy, and Chagas disease to prevent recurrent ventricular tachycardia. Multiple observational studies have demonstrated greater freedom from recurrence with adjunctive epicardial ablation compared with endocardial ablation alone. While epicardial ablation is performed predominantly at tertiary referral centers, knowledge of the technical approach, clinical indications, and potential complications is imperative to maximizing clinical success and patient safety.In 1996, Sosa and colleagues modified the pericardiocentesis technique to enable percutaneous access to the pericardial space for mapping and catheter ablation of ventricular tachycardia.1 Originally developed for patients with epicardial scarring due to chagasic cardiomyopathy and patients with ischemic cardiomyopathy refractory to endocardial ablationm, 2,3 this approach has since become an essential part of the armamentarium for the treatment of ventricular tachycardia. Myocardial scars are three-dimensionally complex with varying degrees of transmurality, and the ability to map and ablate the epicardial surface has contributed to a greater understanding of scar-related VT in postinfarction cardiomyopathy and nonischemic substrates including idiopathic dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, hypertrophic cardiomyopathy, and chagasic cardiomyopathy. In this review, we highlight the percutaneous approach and discuss clinical indications and potential complications.

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“…9,10 Monomorphic VT is rare in patients with hypertrophic cardiomyopathy, and epicardial VT mapping with ablation is often required for successful ablation therapy. 11, 12 However, the success rate is limited because of the increased ventricular wall thickness. 11,12 Bipolar ablation of the interventricular septum (IVS) has been shown, both in vivo and in vitro, to be more efficient than sequential unipolar ablation for creating a transmural lesion.…”

mentioning

confidence: 99%