Surgical cryoablation for ventricular tachyarrhythmia arising from the left ventricular outflow tract region

Choi, Eue Keun; Nagashima, Koichi; Lin, Kaity; Kumar, Saurabh; Barbhaiya, Chirag R.; Baldinger, Samuel H.; Reichlin, Tobias; Michaud, Gregory F.; Couper, Gregory S.; Stevenson, William G.; John, Roy M.

doi:10.1016/j.hrthm.2015.02.016

Cited by 44 publications

(20 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Surgical dissection of the epicardial fat tissue and mobilization of the coronary arteries can potentially localize the arrhythmogenic foci and allow for ablation as described previously. 12,27,28 The left phrenic nerve that passes behind the lateral wall of the LV can also prohibit epicardial RFA. 29 Injury to the phrenic nerve and consequent diaphragmatic paralysis has been reported after epicardial RFA for VT. 30 Proximity to the left phrenic nerve was the main limitation for RFA at the lateral LV wall and can potentially be seen anywhere from the base to the apex and even anteriorly and inferiorly.…”

Section: Discussionmentioning

confidence: 99%

Epicardial Radiofrequency Ablation Failure During Ablation Procedures for Ventricular Arrhythmias

Baldinger

Kumar

Barbhaiya

et al. 2015

Circ: Arrhythmia and Electrophysiology

Self Cite

View full text Add to dashboard Cite

Procedures were performed under conscious sedation or general anesthesia. Programmed ventricular stimulation with ≤3 extrastimuli © 2015 American Heart Association, Inc. Original ArticleBackground-Radiofrequency ablation (RFA) from the epicardial space for ventricular arrhythmias is limited or impossible in some cases. Reasons for epicardial ablation failure and the effect on outcome have not been systematically analyzed. Methods and Results-We assessed reasons for epicardial RFA failure relative to the anatomic target area and the type of heart disease and assessed the effect of failed epicardial RFA on outcome after ablation procedures for ventricular arrhythmias in a large single-center cohort. Epicardial access was attempted during 309 ablation procedures in 277 patients and was achieved in 291 procedures (94%). Unlimited ablation in an identified target region could be performed in 181 cases (59%), limited ablation was possible in 22 cases (7%), and epicardial ablation was deemed not feasible in 88 cases (28%).Reasons for failed or limited ablation were unsuccessful epicardial access (6%), failure to identify an epicardial target (15%), proximity to a coronary artery (13%), proximity to the phrenic nerve (6%), and complications (<1%). Epicardial RFA was impeded in the majority of cases targeting the left ventricular summit region. Acute complications occurred in 9%. The risk for acute ablation failure was 8.3× higher (4.5-15.0; P<0.001) after no or limited epicardial RFA compared with unlimited RFA, and patients with unlimited epicardial RFA had better recurrence-free survival rates (P<0.001). Conclusions-Epicardial RFA for ventricular arrhythmias is often limited even when pericardial access is successful.Variability of success is dependent on the target area, and the presence of factors limiting ablation is associated with worse outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Epicardial Radiofrequency Ablation Failure During Ablation Procedures for Ventricular Arrhythmias

Baldinger

Kumar

Barbhaiya

et al. 2015

Circ: Arrhythmia and Electrophysiology

Self Cite

View full text Add to dashboard Cite

show abstract

“…There are only a few case reports and small case series available in the literature. [12][13][14] Technically, the successful ablation site in our case was adjacent to the proximal LAD artery, just outside the LV summit. However, the same concerns and limitations are applicable, and we believe that the present case adds to the limited literature on surgical mapping and ablation in the LV summit.…”

Section: Discussionmentioning

confidence: 72%

Surgical Mapping and Ablation in the Left Ventricular Summit Guided by Presurgery Pericardial Mapping

Okabe

Rushing

Kalbfleisch

2019

J Innov Cardiac Rhythm Manage.

View full text Add to dashboard Cite

Successful catheter ablation of ventricular arrhythmias arising from the left ventricular (LV) summit is challenging. The use of a catheter-based epicardial approach may be limited due to the proximity of the major coronary arteries and the presence of epicardial fat. Surgical cryoablation in the LV summit is a viable option for drug-refractory ventricular arrhythmias. Presurgical epicardial mapping can facilitate the surgical procedure by localizing the area of interest to allow for a more limited surgical dissection of the epicardial fat.

show abstract

“…However, endocardial ablation may be limited in effectively treating such PVCs arising from the mid‐myocardium or summit of the LV. Novel techniques have been developed in attempt to address sources arising from complex mid‐myocardial or epicardial substrate . Epicardial instrumentation may allow evaluation of substrate remote from the endocardium, but is of limited utility in the LV summit due to proximity of coronary vessels, epicardial fat, and incomplete accessibility to this region via the epicardium .…”

Section: Discussionmentioning

confidence: 99%

Use of half‐normal saline irrigant with cooled radiofrequency ablation within the great cardiac vein to ablate premature ventricular contractions arising from the left ventricular summit

Sandhu¹,

Schuller

Tzou³

et al. 2018

Pacing Clinical Electrophis

View full text Add to dashboard Cite

A 62-year-old man was referred to our institution for high-density, symptomatic premature ventricular contractions (PVCs) with resultant decrease in left ventricular (LV) function having failed prior ablation attempts. Successful, durable ablation of the patient's mid-myocardial PVC arising from the LV summit region was achieved through the proximal great cardiac vein with ablation depth augmented by use of half-normal saline irrigant. Though standard ablation of ventricular arrhythmias using normal saline irrigation from the coronary venous system has been wellreported, this may be of limited value in addressing mid-myocardial sites of origin. This novel case describes the safe use of cooled radiofrequency ablation with use of half-normal saline irrigant from the distal coronary sinus as an option to address complex sites of PVC origin such as the LV summit. K E Y W O R D Sablation, half-normal saline, LV summit, premature ventricular contractions

show abstract

Surgical cryoablation for ventricular tachyarrhythmia arising from the left ventricular outflow tract region

Cited by 44 publications

References 15 publications

Epicardial Radiofrequency Ablation Failure During Ablation Procedures for Ventricular Arrhythmias

Epicardial Radiofrequency Ablation Failure During Ablation Procedures for Ventricular Arrhythmias

Surgical Mapping and Ablation in the Left Ventricular Summit Guided by Presurgery Pericardial Mapping

Use of half‐normal saline irrigant with cooled radiofrequency ablation within the great cardiac vein to ablate premature ventricular contractions arising from the left ventricular summit

Contact Info

Product

Resources

About