Scar Dechanneling

Berruezo, Antonio; Fernández-Armenta, Juan; Andreu, David; Penela, Diego; Herczku, Csaba; Evertz, Reinder; Cipolletta, Laura; Acosta, Juan; Borràs, Roger; Arbelo, Elena; Tolosana, José Marı́a; Brugada, Josép; Mont, Lluı́s

doi:10.1161/circep.114.002386

Cited by 201 publications

(52 citation statements)

References 25 publications

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“…[4][5][6][7][8] In addition, use of percutaneous left ventricular assist devices (LVADs) during ablation, in selected cases, has helped to minimize hemodynamic compromise. 9,10 Not only has the need for repeated VT induction and activation mapping been minimized with contemporary approaches, but freedom from VT recurrence and outcomes have been improved.…”

mentioning

confidence: 99%

Ventricular Tachycardia Ablation in Severe Heart Failure

Tzou¹,

Tung²,

Frankel³

et al. 2017

Circ: Arrhythmia and Electrophysiology

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Background— Ventricular tachycardia (VT) radiofrequency ablation has been associated with reduced VT recurrence and mortality, although it is typically not considered among New York Heart Association class IV (NYHA IV) heart failure patients. We compared characteristics and VT radiofrequency ablation outcomes of those with and without NYHA IV in the International VT Ablation Center Collaboration. Methods and Results— NYHA II–IV patients undergoing VT radiofrequency ablation at 12 international centers were included. Clinical variables, VT recurrence, and mortality were analyzed by NYHA IV status using Kaplan–Meier analysis and Cox proportional hazard models. There were significant differences between NYHA IV (n=111) and NYHA II and III (n=1254) patients: NYHA IV had lower left ventricular ejection fraction; more had diabetes mellitus, kidney disease, cardiac resynchronization implantable cardioverter–defibrillator, and VT storm despite greater antiarrhythmic drug use ( P <0.01). NYHA IV subjects required more hemodynamic support, were inducible for more and slower VTs, and were less likely to undergo final programmed stimulation. There was no significant difference in acute complications. In-hospital deaths, recurrent VT, and 1-year mortality were higher in the NYHA IV group, in the context of greater baseline comorbidities. Importantly, NYHA IV patients without recurrent VT had similar survival compared with NYHA II and III patients with recurrent VT (68% versus 73%). Early VT recurrence (≤30 days) was significantly associated with mortality, especially in NYHA IV patients. Conclusions— Despite greater baseline comorbidities, VT radiofrequency ablation can be safely performed among NYHA IV patients. Early VT recurrence is significantly associated with subsequent mortality regardless of NYHA status. Elimination of recurrent VT in NYHA IV patients may reduce mortality to a level comparable to NYHA II and III with arrhythmia recurrence.

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mentioning

confidence: 99%

Ventricular Tachycardia Ablation in Severe Heart Failure

Tzou¹,

Tung²,

Frankel³

et al. 2017

Circ: Arrhythmia and Electrophysiology

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“…However, detailed mapping studies of local electrograms can identify paths of activation within the scar, forming channels that are considered a more specific target for substrate ablation. 3,4 Ripple mapping (RM) is a method of 3-dimensional activation visualization that displays each electrogram component as a dynamic bar that protrudes from its 3-dimensional location on the surface geometry. 5 The height of each bar correlates with the voltage amplitude of the electrogram at that time point.…”

mentioning

confidence: 99%

A Prospective Study of Ripple Mapping the Post-Infarct Ventricular Scar to Guide Substrate Ablation for Ventricular Tachycardia

Luther

Linton

Jamil‐Copley

et al. 2016

Circ: Arrhythmia and Electrophysiology

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P ost-infarct reentrant ventricular tachycardia (VT) is dependent on channels of surviving myocardium within the infarct scar.1 Substrate-based ablation that eliminates all abnormal electrograms, including fractionated and late potentials within scar, can reduce long-term VT recurrence. However, detailed mapping studies of local electrograms can identify paths of activation within the scar, forming channels that are considered a more specific target for substrate ablation. 3,4 Ripple mapping (RM) is a method of 3-dimensional activation visualization that displays each electrogram component as a dynamic bar that protrudes from its 3-dimensional location on the surface geometry. 5 The height of each bar correlates with the voltage amplitude of the electrogram at that time point. When multiple points are collected, activation is visually apparent from the direction of propagation of bar movement on the map. This is achieved without the need for manual annotation or setting a window of interest. Ripple activation maps can be superimposed on a conventional bipolar voltage map, thereby displaying the surface geometry with both voltage and activation simultaneously.6,7 RM is incorporated into CARTO3v4 (Biosense Webster) and has been © 2016 American Heart Association, Inc. Original ArticleBackground-Post-infarct ventricular tachycardia is associated with channels of surviving myocardium within scar characterized by fractionated and low-amplitude signals usually occurring late during sinus rhythm. Conventional automated algorithms for 3-dimensional electro-anatomic mapping cannot differentiate the delayed local signal of conduction within the scar from the initial far-field signal generated by surrounding healthy tissue. Ripple mapping displays every deflection of an electrogram, thereby providing fully informative activation sequences. We prospectively used CARTO-based ripple maps to identify conducting channels as a target for ablation. Methods and Results-High-density bipolar left ventricular endocardial electrograms were collected using CARTO3v4 in sinus rhythm or ventricular pacing and reviewed for ripple mapping conducting channel identification. Fifteen consecutive patients (median age 68 years, left ventricular ejection fraction 30%) were studied (6 month preprocedural implantable cardioverter defibrillator therapies: median 19 ATP events [Q1-Q3=4-93] and 1 shock [Q1-Q3=0-3]). Scar (<1.5 mV) occupied a median 29% of the total surface area (median 540 points collected within scar). A median of 2 ripple mapping conducting channels were seen within each scar (length 60 mm; initial component 0.44 mV; delayed component 0.20 mV; conduction 55 cm/s). Ablation was performed along all identified ripple mapping conducting channels (median 18 lesions) and any presumed interconnected late-activating sites (median 6 lesions; Q1-Q3=2-12). The diastolic isthmus in ventricular tachycardia was mapped in 3 patients and colocated within the ripple mapping conducting channels identified. Ventricular tachycardia was noninducible in 8...

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“…61 Scar dechanneling represents an alternative method to LAVA abolition with focal ablation performed at sites at which the earliest fractionated potentials are recorded near the entrance of the conducting channels, aiming toward the endpoint of eliminating a consecutive series of LAVA. 62 These substrate-based ablation approaches may be particularly useful in patients who are non-inducible at baseline or in those who have multiple, unmappable arrhythmias. Importantly, these techniques are achievable in most patients …”

Section: J M Sanchez C Yuan and H H Hsiamentioning

confidence: 99%