Transthoracic epicardial catheter ablation to treat recurrent ventricular tachycardia

Sosa, Eduardo; Scanavacca, Maurício; d’Ávila, André

doi:10.1007/s11886-001-0066-1

Cited by 50 publications

(32 citation statements)

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“…Distances of 5 to 12 mm between the catheter tip and the coronary artery may be needed to avoid any risk of injury. 7 Inability to deliver sufficient radiofrequency energy because of high impedance and limited cooling from surrounding blood flow likely contributes to limit the effectiveness of ablation in the GCV. Cooling the saline infusion has been suggested 12 but was not assessed in this study.…”

Section: Discussionmentioning

confidence: 99%

Ventricular Arrhythmias Near the Distal Great Cardiac Vein

Nagashima

Choi

Lin

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Procedures were performed either under conscious sedation or general anesthesia. Using femoral venous and arterial access multipolar electrode catheters were positioned in the coronary sinus to GCV, the right ventricular (RV) apex and the His bundle region. For the patients © 2014 American Heart Association, Inc. Original Article Circ Arrhythm ElectrophysiolBackground-Catheter ablation for ventricular arrhythmia (VA) near the distal great cardiac vein (GCV) is often challenging, and data are limited. Methods and Results-Analysis was performed in 30 patients (19 men; age, 52.8±15.5 years) who underwent catheter ablation for focal VA (11 ventricular tachycardia and 19 premature contractions) with early activation in the GCV (36.7±8.0 ms pre-QRS). Angiography in 27 patients showed earliest GCV site within 5 mm of a coronary artery in 20 (74%). Ablation was performed in the GCV in 15 patients and abolished VA in 8. Ablation was attempted at adjacent non-GCV sites in 19 patients and abolished VA in 5 patients (4 from the left ventricular endocardium and 1 from the left coronary cusp); all success had VA with an initial r wave in lead I and activation ≤7 ms after the GCV (GCV-non-GCV interval). In 13 patients, percutaneous epicardial mapping was performed, but because of adjacent coronaries only 2 received radiofrequency application with VA elimination in 1. Surgical cryoablation was performed in 3 patients and abolished VA in 2. Overall acute success was achieved in 16 (53%) patients. After a median of 2.8 months, 13 patients remained free of VA. Major complications occurred in 4 patients, including coronary injury requiring stenting. Conclusions-Ablation for this arrhythmia is challenging and often limited by the adjacent coronary vessels. Success of anatomically guided endocardial ablation may be identified by a short GCV-non-GCV interval and r wave in lead I. Nagashima et al Ventricular Arrhythmias Near the GCV 907with a history of sustained VT, programmed ventricular stimulation was performed with ≤3 extrastimuli scanned to a minimum coupling interval of 180 ms after basic drives of 600 and 400 ms from 2 RV sites and burst pacing. If sustained VT was not reliably inducible, nonsustained VT or PVCs felt likely to be originating from the same site were targeted. Intravenous infusion of isoproterenol and epinephrine was administered as needed for arrhythmia induction. Mapping and ablation were performed using a 3.5-mm tip catheter (NaviStar ThermoCool or ThermoCool SF; Biosense Webster, Diamond Bar, CA) in 25 patients. In 5 patients, a 4-mm-tip nonirrigated catheter (NaviStar; Biosense Webster) was used initially for mapping (5 patients) and attempted ablation (3 patients) before switching to an irrigated tip catheter. Activation mapping of VT or PVCs used an electroanatomic mapping system (CARTO 3 or XP; Biosense Webster) with bipolar electrograms high-pass filtered at 20 to 30 Hz and low-pass filtered at 400 Hz. Bipolar electrograms were also band pass filtered from 30 to 500 Hz and digitally recorded along with ...

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Section: Discussionmentioning

confidence: 99%

Ventricular Arrhythmias Near the Distal Great Cardiac Vein

Nagashima

Choi

Lin

et al. 2014

Circ: Arrhythmia and Electrophysiology

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“…21 However, severe complications, such as damage to the coronary arteries and the phrenic nerve, were described soon after the introduction of epicardial radiofrequency ablation. 22,23 Since then, many techniques have been introduced with varying success to prevent severe complications, such as coronary angiography, 21 endocardial ablation with an ablation catheter equipped with a retractable needle, 24 endocardial ablation to reduce or obviate epicardial ablation, 25 and injection of air or saline into the pericardium. 26 Recently, Wittkampf et al 14 and du Pré et al 15 have demonstrated that epicardial ablation using electroporation in pigs is feasible, safe, and causes only minimal damage to the coronary arteries.…”

Section: Discussionmentioning

confidence: 99%

Myocardial Lesion Size After Epicardial Electroporation Catheter Ablation After Subxiphoid Puncture

Neven

Driel

Wessel

et al. 2014

Circ: Arrhythmia and Electrophysiology

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“…Epicardial mapping. In eight patients who failed endocardial ablation, epicardial mapping and ablation were attempted at a subsequent session using a modification of the technique described by Sosa et al (13). A 21-gauge micropuncture needle was inserted into the pericardial space for placement of a guide wire, followed by a small introducer that was then sized up to an 8-F introducer sheath.…”

Section: Methodsmentioning

confidence: 99%