Optimized Transseptal Approach for Left Ventricular Tachycardia Ablation in a Patient With a Mechanical Prosthetic Aortic Valve

Param, Rodrigo Isa; Pérez‐Castellano, Nicasio; Pérez-Villacastín, Julián; Moreno, Javier; Ruiz, Eduardo; Solı́s, Jorge

doi:10.1016/s1885-5857(06)60259-4

Cited by 7 publications

(11 citation statements)

References 4 publications

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“…Previous reports have shown bundle-branch reentry and focal VT after valve surgery. [1][2][3]10 The importance of scar-related VT in this population has not been emphasized previously. The scars are often, but not always, located in proximity to a valve annulus.…”

Section: Discussionmentioning

confidence: 85%

Sustained Ventricular Tachycardia Associated With Corrective Valve Surgery

et al. 2007

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Background-The causes of sustained monomorphic ventricular tachycardia (VT) after cardiac valve surgeries have not been studied extensively, although bundle-branch reentry has been reported. Methods and Results-Records of 496 patients referred for electrophysiology study and catheter ablation of recurrent VT were reviewed. Twenty patients (4%) had VT after aortic or mitral valve surgery in the absence of known myocardial infarction. The median age was 53 years, and the median ejection fraction was 45%. In 4 patients, VT occurred early after surgery, and electrophysiology study was performed 3 to 10 days later. In the remaining patients, electrophysiology study was performed a median of 12 years (interquartile range 5 to 15 years) after surgery. Sustained VT was inducible in 17 patients. VT was attributed to scar-related reentry in 14 patients (70%) and to bundle-branch reentry in 2 (10%).Multiple VTs were present in 9 of 14 patients with scar-related reentry. A total of 42 induced VTs were targeted for ablation. Of the 14 patients with scar-related reentry, 9 (64%) had periannular scar, and 10 (71%) had an identifiable endocardial circuit isthmus. Ablation abolished 41 (98%) of the 42 targeted VTs. At a median follow-up of 2.1 years, 3 deaths occurred 8 to 14 months after ablation. One patient with incessant VT early after valve surgery suffered a stroke with residual hemianopsia. Of the 20 patients, 3 required repeat ablation after recurrence, and 2 of these who were not inducible during electrophysiology study had clinical recurrence that necessitated ablation. Conclusions-Sustained VT after valve surgery appears to be bimodal in presentation, occurring either early after surgery or years later. In this referral population, reentry in a region of scar is more common than bundle-branch reentry. Catheter ablation can be successful.

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Section: Discussionmentioning

confidence: 85%

Sustained Ventricular Tachycardia Associated With Corrective Valve Surgery

et al. 2007

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“…However, in this case, that approach was contraindicated because of the mechanical aortic valve replacement. The previous reports demonstrated that a transseptal approach after a mechanical aortic valve replacement was feasible and effective for catheter ablation in the LV 2,3 . In this case, a successful catheter ablation using a transseptal approach was achieved underneath the mechanical prosthetic aortic valve on the blind side for that approach.…”

Section: Discussionmentioning

confidence: 64%

“…The previous reports demonstrated that a transseptal approach after a mechanical aortic valve replacement was feasible and effective for catheter ablation in the LV. 2,3 In this case, a successful catheter ablation using a transseptal approach was achieved underneath the mechanical prosthetic aortic valve on the blind side for that approach. Therefore, this case demonstrated that catheter mapping and ablation of the entire LV using a transseptal approach might be possible.…”

Section: Case Reportmentioning

confidence: 90%

“…The details about the clinical characteristics of sustained monomorphic ventricular tachycardia (VT) after valve surgery have been previously described 1 . However, information about the electrophysiological characteristics of those VTs is limited because prosthetic valves represent a potential problem in the access to the ventricles and may limit the use of radiofrequency (RF) ablation 2,3 . We report a case of a sustained VT originating from underneath a mechanical prosthetic aortic valve, which was cured by RF catheter ablation using a transseptal approach.…”

Section: Introductionmentioning

confidence: 99%

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Successful Radiofrequency Catheter Ablation of Ventricular Tachycardia Originating from Underneath the Mechanical Prosthetic Aortic Valve

Yamada

McElderry

Doppalapudi

et al. 2008

Pacing Clinical Electrophis

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A 67-year-old man who developed sustained ventricular tachycardia (VT) 4 years after a prosthetic aortic valve replacement, underwent electrophysiologic testing and catheter ablation. The mechanism of the VT was suggested to be triggered activity because the VT could be induced by programmed ventricular stimulation, and burst ventricular pacing demonstrated overdrive suppression without a transient entrainment. Successful catheter ablation using a transseptal approach was achieved underneath the mechanical prosthetic aortic valve on the blind side for that approach. This case demonstrated that catheter mapping and ablation of the entire LV using a transseptal approach might be possible.

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“…Nejčastějším mechanismem je reentry v jizevnatém substrátu po operaci chlopní, 1 vzácnějším zdrojem mohou být arytmie z převodního systému komor mechanismu bundle-branch reentry, 2 mikroreentry nebo spouštěné aktivity 3 a konečně vzácným zdrojem může být fokální aktivita z oblasti mimo převodní systém. 4,5 Do 30 dnů po operaci převažují bundle-branch reentry KT, v pozdějším období naopak KT v souvislosti s jizvou. 1,2 Setrvalé KT časně po kardiochirurgické operaci nejsou časté.…”

Section: Diskuseunclassified

Transaortic ablation of incessant ventricular tachycardia after aortic valve replacement by a mechanical prosthesis

Szmek¹,

Neuwirth²,

Fiala³

2010

Cor Vasa

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Szmek B, Neuwirth R, Fiala M. Transaortální ablace incesantní komorové tachykardie po náhradě aortální chlopně mechanickou protézou. Cor Vasa 2010;52:643-645. V kasuistice prezentujeme případ mladé pacientky po náhradě aortální chlopně pro závažnou regurgitaci při infekční endokarditidě, u které byl pooperační průběh komplikován vznikem incesantní pravidelné tachykardie se štíhlým komplexem QRS. Pro přechodnou pooperační AV blokádu II. stupně, která neumožňovala nasazení antiarytmik, bylo provedeno elektrofyziologické vyšetření s nálezem komorového původu arytmie. Fokus ve výtokovém traktu levé komory v blízkosti Hisova svazku byl následně odstraněn radiofrekvenční ablací retrográdním přístupem přes mechanickou protézu. Klíčová slova: Aortální chlopeň -Mechanická náhrada -Komorová tachykardie -Katetrová ablace Szmek B, Neuwirth R, Fiala M. Transaortic ablation of incessant ventricular tachycardia after aortic valve replacement by a mechanical prosthesis. Cor Vasa 2010;52:643-645.We present the case of a young lady who underwent aortic valve replacement for serious regurgitation due to infectious endocarditis and in whom the postoperative course was complicated by incessant regular tachycardia with a narrow QRS complex. Because of a transient postoperative second-degree AV block, which precluded antiarrhythmic therapy commencement, she underwent an electrophysiological study demonstrating ventricular origin of the arrhythmia. The focal source in the left ventricular outfl ow tract was subsequently eliminated by radiofrequency ablation using the retrograde approach through the mechanical prosthesis.

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Optimized Transseptal Approach for Left Ventricular Tachycardia Ablation in a Patient With a Mechanical Prosthetic Aortic Valve

Cited by 7 publications

References 4 publications

Sustained Ventricular Tachycardia Associated With Corrective Valve Surgery

Sustained Ventricular Tachycardia Associated With Corrective Valve Surgery

Successful Radiofrequency Catheter Ablation of Ventricular Tachycardia Originating from Underneath the Mechanical Prosthetic Aortic Valve

Transaortic ablation of incessant ventricular tachycardia after aortic valve replacement by a mechanical prosthesis

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