Novel utility of cryoablation for ventricular arrhythmias arising from the left aortic cusp near the left main coronary artery: A case series

Rhee, Edward K.; Srivathsan, Komandoor; Su, Wilber

doi:10.1016/j.hrthm.2013.10.008

Cited by 18 publications

(24 citation statements)

References 11 publications

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“…19,20 Cryothermal safety profile is ALPM indicates anterolateral papillary muscle; NOTCH, high-frequency component of the QRS complex; PMPM, posteromedial papillary muscle; PMS, pace-mapping score; PP, Purkinje potentials; QRSA, QRS axis; QRSD, QRS complex duration; QRSM, QRS complex morphology in V1; R/S transition, precordial lead at which the QRS becomes predominantly negative; SpA, number of patients in which the clinical arrhythmia was spontaneous during the procedure; and VEGM-QRS, time interval from the ventricular electrogram to the first QRS deflection during the clinical arrhythmia. Localization=origin of the clinical arrhythmia at the apex, body, or base of the papillary muscle.…”

Section: Cryoenergymentioning

confidence: 99%

Results of Cryoenergy and Radiofrequency-Based Catheter Ablation for Treating Ventricular Arrhythmias Arising From the Papillary Muscles of the Left Ventricle, Guided by Intracardiac Echocardiography and Image Integration

Rivera

Ricapito

Linkevičius

et al. 2016

Circ: Arrhythmia and Electrophysiology

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T he papillary muscles (PMs) from the left ventricle (LV) have been shown to be a potential site of origin of ventricular arrhythmias (VAs) in patients with and without structural heart disease.1 Catheter ablation has been described as an effective treatment for these arrhythmias, although radiofrequency delivery at these regions has been associated with poor manipulation and catheter stability compared with other VAs. 2 See Editorial by Latchamsetty and BogunPrevious data on catheter cryoablation of PMs VAs showed high-success and low complication rates. 3 There is yet no data available comparing results of both cryoenergy and radiofrequency for catheter cryoablation of PM-related arrhythmias.This study compares procedural outcomes and recurrence rate after catheter cryoablation or radiofrequency ablation for the treatment of ventricular tachycardia (VT) and premature ventricular complexes (PVCs) localized at the PMs of the LV, with the aid of intracardiac echocardiography (ICE) and image integration. MethodsA total of 21 patients with recurrent VAs originating at the PMs of the LV were identified from retrospective review of 189 consecutive patients (men 52%, age 44 years, range 28-54 years) with symptomatic sustained VT (n=58), nonsustained VT (n=40), or PVC (n=91) referred for catheter ablation to the Buenos Aires Cardiovascular Institute (Buenos Aires, Argentina) between January 2014 and January 2016. Scar-related VT was observed in 45 patients (24%). The sites of origin of idiopathic VAs included the right ventricular (RV) outflow tract in 82 (43%), aortomitral continuity in 24 (13%), posteromedial PM (PMPM) in 19 (10%), anterolateral PM (ALPM) in 3 (1.5%), aortic root in 3 (1.5%), fascicles of the left bundle branch in 2 (1%), mitral annulus in 1 (0.5%), and other sites in 11 (6%). This study retrospectively included 21 patients with symptomatic, drug refractory, and single morphology VAs originated at the PMs of the LV. The institutional review committee approved the study and © 2016 American Heart Association, Inc. Circ Arrhythm Electrophysiol Original ArticleBackground-Catheter radiofrequency ablation of ventricular arrhythmias (VAs) arising from the left ventricle's papillary muscles has been associated with inconsistent results. The use of cryoenergy versus radiofrequency has not been compared yet. This study compares outcomes and complications of catheter ablation of VA from the papillary muscles of the left ventricle with either cryoenergy or radiofrequency. Methods and Results-Twenty-one patients (40±12 years old; 47% males; median ejection fraction 59±7.3%) with drug refractory premature ventricular contractions or ventricular tachycardia underwent catheter cryoablation or radiofrequency ablation. VAs were localized using 3-dimensional mapping, multidetector computed tomography, and intracardiac echocardiography, with arrhythmia foci being mapped at either the anterolateral papillary muscle or posteromedial papillary muscles of the left ventricle. Focal ablation was performed using an 8-mm cryoa...

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Section: Cryoenergymentioning

confidence: 99%

Results of Cryoenergy and Radiofrequency-Based Catheter Ablation for Treating Ventricular Arrhythmias Arising From the Papillary Muscles of the Left Ventricle, Guided by Intracardiac Echocardiography and Image Integration

Rivera

Ricapito

Linkevičius

et al. 2016

Circ: Arrhythmia and Electrophysiology

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“…Prior descriptions of cryoablation at the aortic cusps have been well correlated with significant vasospasm and ST-segment upstroke, 11 while animal studies have shown that catheter-based cryoablation can produce lesions in the musculature of the adjacent ventricle when accessed from the CSS without significant injury to the CS or adjacent artery 15 . Our case shows the development of a mild vasospasm, without any major clinical significance.…”

Section: Discussionmentioning

confidence: 51%

“…Cryoablation has been reported as a safe and effective alternative for catheter ablation of ventricular arrhythmias 9, 10, 11, 12. Cryothermal safety profile is attributed to the mechanism of tissue destruction.…”

Section: Discussionmentioning

confidence: 99%

Coronary artery vasospasm during catheter cryoablation of left ventricular summit nonsustained ventricular tachycardia

Rivera

Ricapito

Parodi

et al. 2016

HeartRhythm Case Reports

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“…There are other indications for cryoablation, such as to avoid damage to the coronary arteries . However, there were no patients who underwent cryoablation to avoid the coronary arteries in this case series.…”

Section: Discussionmentioning

confidence: 99%

Outcome of combined cryo‐ and radiofrequency‐catheter ablation in patients with supraventricular tachycardias

Miyamoto

Kapa

Mulpuru

et al. 2019

Cardiovasc electrophysiol

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Background There are few data regarding the outcome of a combined cryo‐ and radiofrequency (RF)‐catheter ablation of various types of supraventricular tachycardias (SVTs) originating from near the normal conduction system. METHODS We analyzed all patients undergoing combined cryo‐ and RF‐ catheter ablation at Mayo Clinic, Rochester, MN as part of the ablation of SVTs with potential risks of injury to the normal conduction system. This study aimed to assess the outcome of a combined cryo‐ and RF‐catheter ablation of various types of SVTs. RESULTS The study population consisted of 54 patients (38 ± 17 years, 32 men). A combined cryo‐ and RF‐catheter ablation was attempted for septal accessary pathways (APs) in 26, atrioventricular nodal reentrant tachycardia (AVNRT) in 14, atrial tachycardia (AT) in 7, and junctional ectopic tachycardia in 7 patients. Forty‐one patients (76%) were successfully ablated with cryoablation, and RF ablation after an unsuccessful cryoablation ablated the SVTs successfully at the same location in 6 patients (11%). Complication occurred in 1 patient (deep vein thrombosis). The cumulative freedom from SVT rate at 30 days after the procedure was 78% and there was no significant difference in the recurrence rate among the SVTs. CONCLUSION A combined cryo‐ and RF‐catheter ablation is clinically effective in patients undergoing SVT ablation with the potential risk of injury to the normal conduction system.

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Novel utility of cryoablation for ventricular arrhythmias arising from the left aortic cusp near the left main coronary artery: A case series

Cited by 18 publications

References 11 publications

Results of Cryoenergy and Radiofrequency-Based Catheter Ablation for Treating Ventricular Arrhythmias Arising From the Papillary Muscles of the Left Ventricle, Guided by Intracardiac Echocardiography and Image Integration

Results of Cryoenergy and Radiofrequency-Based Catheter Ablation for Treating Ventricular Arrhythmias Arising From the Papillary Muscles of the Left Ventricle, Guided by Intracardiac Echocardiography and Image Integration

Coronary artery vasospasm during catheter cryoablation of left ventricular summit nonsustained ventricular tachycardia

Outcome of combined cryo‐ and radiofrequency‐catheter ablation in patients with supraventricular tachycardias

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