Outcome of rescue ablation in patients with refractory ventricular electrical storm requiring mechanical circulation support

Chung, Fa Po; Liao, Ying; Lin, Yenn Jiang; Chang, Shih Lin; Lo, Li Wei; Hu, Yu Feng; Tuan, Ta Chuan; Chao, Tze Fan; Liao, Jo Nan; Chang, Tsan‐Kuo; Vicera, Jennifer Jeanne B.; Chin, Chye Gen; Wu, Chen-Tu; Liu, Chih Min; Lee, Po Tseng; Huang, Ting Chun; Lugtu, Isaiah C.; Chen, Shih Ann

doi:10.1111/jce.14309

Cited by 7 publications

(6 citation statements)

References 31 publications

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“…In brief, after obtaining informed consent, we performed a standardized EP study and RFCA in all patients under conscious sedation or general anesthesia. All antiarrhythmic drugs except amiodarone were discontinued for at least five half‐lives before RFCA 22–24 . The selection of patients for epicardial mapping and ablation was based on the operators' discretion, failed endocardial ablation, ECG features, etiologies of cardiomyopathy, and epicardial scar identified using cardiac MRI.…”

Section: Methodsmentioning

confidence: 99%

“…All antiarrhythmic drugs except amiodarone were discontinued for at least five half-lives before RFCA. [22][23][24] The selection of patients for epicardial Endocardial bipolar scar and low voltage zone (LVZ) were defined as areas with a peak-to-peak bipolar voltage <0.5 mV and 0.5-1.5 mV, respectively. Epicardial LVZ was defined as a bipolar voltage of 0.5-1.0 mV.…”

Section: Ep Study and Substrate Mappingmentioning

confidence: 99%

“…The details of the EP study and substrate mapping have been described in our previous work. [22][23][24] In brief, after obtaining informed consent, we performed a standardized EP study and RFCA in all patients under conscious sedation or general anesthesia. All antiarrhythmic drugs except amiodarone were discontinued for at least five half-lives before RFCA.…”

Section: Ep Study and Substrate Mappingmentioning

confidence: 99%

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Application of Ensite™ LiveView function for identification of scar‐related ventricular tachycardia isthmus

Kao

Chung

Lin

et al. 2022

Cardiovasc electrophysiol

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Introduction Dynamic display of real‐time wavefront activation pattern may facilitate the recognition of reentrant circuits, particularly the diastolic path of ventricular tachycardia (VT). Objective We aimed to evaluate the feasibility of LiveView Dynamic Display for mapping the critical isthmus of scar‐related reentrant VT. Methods Patients with mappable scar‐related reentrant VT were selected. The characteristics of the underlying substrates and VT circuits were assessed using HD grid multielectrode catheter. The VT isthmuses were identified based on the activation map, entrainment, and ablation results. The accuracy of the LiveView findings in detecting potential VT isthmus was assessed. Results We studied 18 scar‐related reentrant VTs in 10 patients (median age: 59.5 years, 100% male) including 6 and 4 patients with ischemic and nonischemic cardiomyopathy, respectively. The median VT cycle length was 426 ms (interquartile range: 386–466 ms). Among 590 regional mapping displays, 92.0% of the VT isthmus sites were identified by LiveView Dynamic Display. The accuracy of LiveView for isthmus identification was 84%, with positive and negative predictive values of 54.8% and 97.8%, respectively. The area with abnormal electrograms was negatively correlated with the accuracy of LiveView Dynamic Display (r = −.506, p = .027). The median time interval to identify a VT isthmus using LiveView was significantly shorter than that using conventional activation maps (50.5 [29.8–120] vs. 219 [157.5–400.8] s, p = .015). Conclusion This study demonstrated the feasibility of LiveView Dynamic Display in identifying the critical isthmus of scar‐related VT with modest accuracy.

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Section: Methodsmentioning

confidence: 99%

Section: Ep Study and Substrate Mappingmentioning

confidence: 99%

Section: Ep Study and Substrate Mappingmentioning

confidence: 99%

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Application of Ensite™ LiveView function for identification of scar‐related ventricular tachycardia isthmus

Kao

Chung

Lin

et al. 2022

Cardiovasc electrophysiol

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“…However, reported mortality rates in the short-term are high, ranging from 38 to 76%, despite successful CA. 179 , 180 Of note, rescue MCS during CA was associated with a higher mortality rate than pre-emptive MCS or no-MCS. 181 …”

Section: Acute Managementmentioning

confidence: 97%

Management of patients with an electrical storm or clustered ventricular arrhythmias: a clinical consensus statement of the European Heart Rhythm Association of the ESC—endorsed by the Asia-Pacific Heart Rhythm Society, Heart Rhythm Society, and Latin-American Heart Rhythm Society

Lenarczyk,

Zeppenfeld,

Tfelt-Hansen

et al. 2024

Europace

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Electrical storm (ES) is a state of electrical instability, manifesting as recurrent ventricular arrhythmias (VAs) over a short period of time (three or more episodes of sustained VA within 24 h, separated by at least 5 min, requiring termination by an intervention). The clinical presentation can vary, but ES is usually a cardiac emergency. Electrical storm mainly affects patients with structural or primary electrical heart disease, often with an implantable cardioverter-defibrillator (ICD). Management of ES requires a multi-faceted approach and the involvement of multi-disciplinary teams, but despite advanced treatment and often invasive procedures, it is associated with high morbidity and mortality. With an ageing population, longer survival of heart failure patients, and an increasing number of patients with ICD, the incidence of ES is expected to increase. This European Heart Rhythm Association clinical consensus statement focuses on pathophysiology, clinical presentation, diagnostic evaluation, and acute and long-term management of patients presenting with ES or clustered VA.

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“…The patients supported predominantly by urgent VA ECMO for periprocedural life-threatening arrhythmias were characterized by older age, more ischemic cardiomyopathies, worse LV ejection fraction, and more comorbidities than the control group. Regardless of unfavorable profiles and the rates of pump failures in the VA ECMO cohort, the rescue ablation successfully prevented recurrences of ventricular arrhythmias and resulted in a comparable 1-year outcome between arrhythmic storms with and without VA ECMO support ( 65 ).…”

Section: Venoarterial Ecmo In Arrhythmic Stormsmentioning

confidence: 99%

Mechanical circulatory support in ventricular arrhythmias

Tavazzi

Dammassa

Colombo

et al. 2022

Front. Cardiovasc. Med.

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In atrial and ventricular tachyarrhythmias, reduced time for ventricular filling and loss of atrial contribution lead to a significant reduction in cardiac output, resulting in cardiogenic shock. This may also occur during catheter ablation in 11% of overall procedures and is associated with increased mortality. Managing cardiogenic shock and (supra) ventricular arrhythmias is particularly challenging. Inotropic support may exacerbate tachyarrhythmias or accelerate heart rate; antiarrhythmic drugs often come with negative inotropic effects, and electrical reconversions may risk worsening circulatory failure or even cardiac arrest. The drop in native cardiac output during an arrhythmic storm can be partly covered by the insertion of percutaneous mechanical circulatory support (MCS) devices guaranteeing end-organ perfusion. This provides physicians a time window of stability to investigate the underlying cause of arrhythmia and allow proper therapeutic interventions (e.g., percutaneous coronary intervention and catheter ablation). Temporary MCS can be used in the case of overt hemodynamic decompensation or as a “preemptive strategy” to avoid circulatory instability during interventional cardiology procedures in high-risk patients. Despite the increasing use of MCS in cardiogenic shock and during catheter ablation procedures, the recommendation level is still low, considering the lack of large observational studies and randomized clinical trials. Therefore, the evidence on the timing and the kinds of MCS devices has also scarcely been investigated. In the current review, we discuss the available evidence in the literature and gaps in knowledge on the use of MCS devices in the setting of ventricular arrhythmias and arrhythmic storms, including a specific focus on pathophysiology and related therapies.

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Outcome of rescue ablation in patients with refractory ventricular electrical storm requiring mechanical circulation support

Cited by 7 publications

References 31 publications

Application of Ensite™ LiveView function for identification of scar‐related ventricular tachycardia isthmus

Application of Ensite™ LiveView function for identification of scar‐related ventricular tachycardia isthmus

Management of patients with an electrical storm or clustered ventricular arrhythmias: a clinical consensus statement of the European Heart Rhythm Association of the ESC—endorsed by the Asia-Pacific Heart Rhythm Society, Heart Rhythm Society, and Latin-American Heart Rhythm Society

Mechanical circulatory support in ventricular arrhythmias

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