Saline-Cooled Versus Standard Radiofrequency Catheter Ablation for Infarct-Related Ventricular Tachycardias

Soejima, Kyoko; Delacrétaz, Etienne; Suzuki, Makoto; Brunckhorst, Corinna; Maisel, William H.; Friedman, Peter L.; Stevenson, William G.

doi:10.1161/01.cir.103.14.1858

Cited by 122 publications

(65 citation statements)

References 18 publications

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“…Irrigated radiofrequency ablation electrodes create larger lesions than standard 4-mm electrodes, making them of particular interest for ablation of scar-related VTs, in which the reentry circuits are often relatively wide and can extend deep within the myocardium. [15][16][17] Despite a population of patients with severely depressed ventricular function and drug-refractory, frequent arrhythmias, recurrent VT was abolished in approximately half of the patients. For many of those in whom VT recurred, the frequency of episodes was substantially reduced.…”

Section: Discussionmentioning

confidence: 99%

“…By cooling the electrode-tissue interface, irrigated electrodes are able to deliver greater radiofrequency power to the tissue, produce larger lesions than radiofrequency ablation with standard solid electrodes, and have been suggested to facilitate ablation. 15,16 The Thermocool VT trial was conducted to evaluate the safety and efficacy of a radiofrequency ablation catheter with external irrigation combined with an electroanatomic mapping system for ablation of recurrent VT caused by prior myocardial infarction.…”

Section: Clinical Perspective P 2782mentioning

confidence: 99%

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Irrigated Radiofrequency Catheter Ablation Guided by Electroanatomic Mapping for Recurrent Ventricular Tachycardia After Myocardial Infarction

et al. 2008

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Background-Recurrent ventricular tachycardia (VT) is an important cause of mortality and morbidity late after myocardial infarction. With frequent use of implantable cardioverter-defibrillators, these VTs are often poorly defined and not tolerated for mapping, factors previously viewed as relative contraindications to ablation. This observational multicenter study assessed the outcome of VT ablation with a saline-irrigated catheter combined with an electroanatomic mapping system. Methods and Results-Two hundred thirty-one patients (median LV ejection fraction, 0.25; heart failure in 62%) with recurrent episodes of monomorphic VT (median, 11 in the preceding 6 months) caused by prior myocardial infarction were enrolled. All inducible monomorphic VTs with a rate approximating or slower than any spontaneous VTs were targeted for ablation guided by electroanatomic mapping during sinus rhythm and/or VT. Patients were not excluded for multiple VTs (median, 3 per patient) or unmappable VT (present in 69% of patients). Ablation abolished all inducible VTs in 49% of patients. The primary end point of freedom from recurrent incessant VT or intermittent VT after 6 months of follow-up was achieved for 123 patients (53%). In 142 patients with implantable cardioverter-defibrillators before and after ablation for intermittent VT who survived 6 months, VT episodes were reduced from a median of 11.5 to 0 (PϽ0.0001). The 1-year mortality rate was 18%, with 72.5% of deaths attributed to ventricular arrhythmias or heart failure. The procedure mortality rate was 3%, with no strokes. Conclusions-Catheter ablation is a reasonable option to reduce episodes of recurrent VT in patients with prior myocardial infarction, even when multiple and/or unmappable VTs are present. This population remains at high risk for death, warranting surveillance and further study. (Circulation. 2008;118:2773-2782.)

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Perspective P 2782mentioning

confidence: 99%

Irrigated Radiofrequency Catheter Ablation Guided by Electroanatomic Mapping for Recurrent Ventricular Tachycardia After Myocardial Infarction

et al. 2008

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“…In case of epicardial access, a subxiphoidal puncture is used [12]. Irrigated radiofrequency (RF) ablation is preferred both for deeper lesion formation and for the prevention of thrombus formation at the ablation site [13].…”

Section: Methodsmentioning

confidence: 99%

VT ablation in heart failure

Bänsch

Schneider

Akın

et al. 2012

Herzschr. Elektrophys.

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Ventricular tachycardias (VT), shocks, and clusters of shock are ominous signs in patients with implantable cardioverter-defibrillators and herald an increased risk of hospitalization and mortality. VT clusters have been associated with aggravation of heart failure (19%), acute coronary events (14%), and electrolyte imbalance (10%). Yet, any association of potential causative factors and aggravation of VT is vague. Maybe, in patients with any substrate for re-entry, progressive aggravation of ventricular dysrhythmias is to be expected. The high recurrence rate of electrical storm despite antiarrhythmic drug therapy supports this view. The optimal timing of VT ablation is unknown, but current convention is to perform VT ablation after shock clusters or incessant VT has occurred. Preemptive VT ablation before VT has occurred is rarely performed (only in 15% of active centers) and the majority of centers never perform VT ablation even after the first shock. Such practice is within guidelines that recommend VT ablation only in ICD patients with recurrent or incessant VT. However, there is strong data in support of preemptive VT ablation.

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“…Early experiences with catheter ablation in this clinical setting reported a significant association between noninducibility at the end of the procedure and VT-free survival. [12][13][14][15][16] Subsequent studies including larger patient populations have provided mixed results. 4,6,7,9,12,13,15,[17][18][19][20][21][22][23][24][25][26][27] It is important to emphasize that none of these studies was specifically designed to perform a formal longitudinal evaluation of noninducibility as a predictor of postablation recurrences, and only 2 studies had a prospective randomized design.…”

Section: Invasive Pesmentioning

confidence: 99%

End Points for Ablation of Scar-Related Ventricular Tachycardia

Frankel

Marchlinski

2014

Circ: Arrhythmia and Electrophysiology

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T he goal of catheter ablation strategies for the treatment of scar-related ventricular tachycardia (VT) is the interruption of critical areas of slow conduction within the VT circuits responsible for the development and maintenance of VTs. 1,2 Clinical studies have consistently shown the superiority of radiofrequency catheter ablation compared with standard medical therapy in controlling recurrent VT. 3,4 However, even after an acutely successful ablation, the long-term freedom from recurrent VT remains suboptimal, especially in patients with nonischemic substrates where the recurrence rates for longterm follow-up can be as high as 77%.5 Identification of the optimal end points for VT ablation is crucial to improve the success rate of this procedure. The response to programmed electric stimulation (PES) at the end of the procedure has been traditionally used to evaluate the acute success and predict longterm outcomes.1,2 Noninducibility by PES represents a classical end point for VT ablation and the only 1 endorsed by the current practice guidelines.1,2 Of note, a direct association between VT noninducibility at the end of the procedure and long-term arrhythmia-free survival has been suggested but not uniformly demonstrated. 4,[6][7][8][9] More recently, the increasing adoption of substrate-based ablation techniques, which target specific electrograms indexing slow conduction (ie, abnormal, split, and late electrograms) in sinus rhythm and reasonable surrogates for the VT isthmus, 10,11 has been paralleled by an increasing need for new ablation end points. Although noninducibility at PES has been used as an end point also in studies evaluating substratebased ablation approaches, other procedural end points have been described to validate the completeness of linear lesions and the elimination of abnormal potentials within the scar. This review will summarize the state of the art regarding procedural end points for catheter ablation of scar-related VT (Table 1). Invasive PESNoninducibility at PES represents the most widely accepted end point for catheter ablation of scar-related VT. The most recent expert consensus document on VT ablation endorses noninducibility of the presumed clinical VT as the minimum end point for catheter ablation of scar-related VT; other end points beyond noninducibility are discussed but not specifically endorsed, because they have not been systematically validated.1,2 The bulk of the evidence supporting noninducibility at PES as a procedural end point derives from studies including patients with infarct-related VT (Table 2). Early experiences with catheter ablation in this clinical setting reported a significant association between noninducibility at the end of the procedure and VT-free survival.12-16 Subsequent studies including larger patient populations have provided mixed results. 4,6,7,9,12,13,15,[17][18][19][20][21][22][23][24][25][26][27] It is important to emphasize that none of these studies was specifically designed to perform a formal longitudinal evaluation of noninducibili...

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Saline-Cooled Versus Standard Radiofrequency Catheter Ablation for Infarct-Related Ventricular Tachycardias

Cited by 122 publications

References 18 publications

Irrigated Radiofrequency Catheter Ablation Guided by Electroanatomic Mapping for Recurrent Ventricular Tachycardia After Myocardial Infarction

Irrigated Radiofrequency Catheter Ablation Guided by Electroanatomic Mapping for Recurrent Ventricular Tachycardia After Myocardial Infarction

VT ablation in heart failure

End Points for Ablation of Scar-Related Ventricular Tachycardia

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