Urgent catheter ablation for sustained ventricular tachyarrhythmias in patients with acute heart failure decompensation

Hayashi, Meiso; Miyauchi, Yasushi; Murata, Hiroshige; Takahashi, Katsumi; Tsuboi, Ippei; Uetake, Shunsuke; Hayashi, Hiroshi; Horie, Tsutomu; Yodogawa, Kenji; Iwasaki, Yu‐ki; Mizuno, Kyoichi

doi:10.1093/europace/eut207

Cited by 15 publications

(12 citation statements)

References 21 publications

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“…Two common modalities of measuring electrical properties of prints are sheet resistance and time domain reflectometry. Such investigations have been performed on prints on fabric by [8,27,28] (sheet resistance) and [28,29] (time domain reflectometry). However, in the application of electrodes, the print is in contact with an electrolyte which adds a frequency dependency.…”

Section: Discussionmentioning

confidence: 99%

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Properties of screen printed electrocardiography smartware electrodes investigated in an electro-chemical cell

Rattfält

Björefors

Nilsson³

et al. 2013

BioMedical Engineering OnLine

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BackgroundECG (Electrocardiogram) measurements in home health care demands new sensor solutions. In this study, six different configurations of screen printed conductive ink electrodes have been evaluated with respect to electrode potential variations and electrode impedance.MethodsThe electrode surfaces consisted of a Ag/AgCl-based ink with a conduction line of carbon or Ag-based ink underneath. On top, a lacquer layer was used to define the electrode area and to cover the conduction lines. Measurements were performed under well-defined electro-chemical conditions in a physiologic saline solution.ResultsThe results showed that all printed electrodes were stable and have a very small potential drift (less than 3 mV/30 min). The contribution to the total impedance was 2% of the set maximal allowed impedance (maximally 1 kΩ at 50 Hz), assuming common values of input impedance and common mode rejection ratio of a regular amplifier.ConclusionOur conclusions are that the tested electrodes show satisfying properties to be used as elements in a skin electrode design that could be suitable for further investigations by applying the electrodes on the skin.

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Section: Discussionmentioning

confidence: 99%

“…impedance characteristics that depend on for example stretch [4,6]. Printed electronics technology has emerged as a new attractive tool in producing smartware [7,8]. This technology has the potential to provide smartware electrodes with improved characteristics.…”

Section: Introductionmentioning

confidence: 99%

Properties of screen printed electrocardiography smartware electrodes investigated in an electro-chemical cell

Rattfält

Björefors

Nilsson³

et al. 2013

BioMedical Engineering OnLine

View full text Add to dashboard Cite

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“…However, electroanatomical mapping of the entire affected region is often required in the ablation of scarrelated VT, and all of the possible critical isthmuses must be eliminated within the wide scar areas. The efficacy of VF storm ablation 6,21 and urgent ablation for ventricular arrhythmias during acute heart failure 22 has already been reported. In this study, VF recurrence was present in 6 patients; however, the electrical storms had subsided and all the recurrent arrhythmias were controlled by medical therapy alone.…”

Section: Conversion To Monomorphic Vt After Vf Ablationmentioning

confidence: 99%

Conversion to Purkinje-Related Monomorphic Ventricular Tachycardia After Ablation of Ventricular Fibrillation in Ischemic Heart Disease

Masuda

Nogami

Kuroki

et al. 2016

Circ: Arrhythmia and Electrophysiology

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V entricular fibrillation (VF) is a life-threatening arrhythmia that often occurs in patients with ischemic heart disease (IHD). The Purkinje system has been reported to play a pivotal role in triggering and perpetuating VF, 1 and catheter ablation targeting Purkinje potentials can suppress this arrhythmia.2-9 Catheter ablation is an effective therapy and seems to have a high success rate for the treatment of VF associated with Purkinje system in general. However, some patients experience newly emergent monomorphic ventricular tachycardia (VT) after VF ablation.The mechanism of VF conversion to monomorphic VT is unclear, but we hypothesized that catheter ablation of cardiac tissue results in conduction delay within the Purkinje network to generate new VT circuits. The aim of this study was to evaluate the prevalence and underlying mechanism of monomorphic VT after VF ablation and its outcome over long-term follow-up. Methods PatientsData about 21 consecutive patients who underwent catheter ablation of primary VF because of IHD between December 2003 and May 2014 were retrospectively analyzed. This study was approved by the institutional review boards of each of the 5 participating hospitals. Twenty of 21 patients were in electrical storm (>3 VF episodes per 24 hours). The diagnosis of IHD was based on past medical history and clinical findings. Coronary angiography was performed in all patients. Before VF ablation, various therapies were attempted, including coronary revascularization, heart failure treatment, antiarrhythmic medications, deep sedation, and overdrive pacing. However, VF was refractory to those therapies, © 2016 American Heart Association, Inc. Original ArticleBackground-Catheter ablation is an effective therapy for ventricular fibrillation (VF) arising from the Purkinje system in ischemic heart disease. However, some patients experience newly emergent monomorphic ventricular tachycardia (VT) after the ablation of VF. We evaluated the prevalence and mechanism of monomorphic VT after VF ablation. Methods and Results-Twenty-one consecutive patients with primary VF because of ischemic heart disease who underwent catheter ablation were retrospectively analyzed. Twenty of 21 patients were in electrical storm. Ventricular premature contractions triggering VF arose from the left Purkinje system and were targeted for ablation. Before the ablation, 14 of 21 patients had only VF, and the other 7 had VF and concomitant monomorphic VT. Four of the 14 patients with only VF (29%) exhibited newly emergent monomorphic VT after VF ablation. Three of these patients had Purkinje-related VTs, which were successfully eliminated by the ablation of a Purkinje network located in the same low-voltage area as the site of prior successful VF ablation. During a median follow-up of 28 months (interquartile range, 16-68 months), VF recurred in 6 of 21 patients (29%); however, there were neither electrical storms nor monomorphic VT, and all recurring arrhythmias were controlled by medical therapy alone. Conclusions-Over one fif...

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“…Ablation was then performed to transect the identified isthmus. In patients with premature ventricular contractions (PVCs) preceding VF, radiofrequency energy applications were carried out at the earliest activation site or the site where a similar paced QRS morphology as the spontaneous PVC was recorded or at both sites 9 .…”

Section: Electrophysiologic Study and Catheter Ablationmentioning

confidence: 99%

“…The efficacy of RFCA has been reported in patients with electrical storms in the setting of an acute myocardial infarction 5,6 , chronic ischemic heart disease 7,8 , cardiomyopathies 7,8 , and acute heart failure decompensation 9 . Furthermore, RFCA eliminates monomorphic VTs and polymorphic VT/VF attacks by eliminating the initial PVC, which trigger these arrhythmias and often emerges in the damaged but surviving Purkinje network 6,9 . In the present study 1 patient of the urgent group also exhibited VF storms triggered by monomorphic PVCs, which were successfully ablated without any recurrence of VF at the site exhibiting a Purkinje potential.…”

Section: Urgent Catheter Ablationmentioning

confidence: 99%

Urgent Catheter Ablation in Octogenarians with Serious Tachyarrhythmias

et al. 2016

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Background: Urgent catheter ablation is often required for various tachyarrhythmias; however, its efficacy and safety in elderly patients have not been fully elucidated.Methods: This study included consecutive octogenarians who underwent urgent radiofrequency catheter ablation (RFCA) for various serious tachyarrhythmias (urgent group, n=28) that were lifethreatening, hemodynamically deleterious, or provoking ischemia, and consecutive octogenarians who underwent elective RFCA (control group, n=36). The rate of a successful RFCA, complications, later arrhythmia recurrences, and mortality were compared between the groups.Results: There was no significant difference in the breakdown of the targeted arrhythmias between the groups, and common-type atrial flutter was most often targeted in both the urgent group (57%) and the elective group (56%). Compared with the control group patients, the patients of the urgent group were older (84 3 vs. 82 2 years P=0.001), with a higher frequency of baseline heart disease (68% vs. 17%, P <0.001) and lower left ventricular ejection fraction (45% 15% vs. 68% 10%, P<0.001). The rates of acute success (100% vs. 100%, P=1.00) and later arrhythmia recurrences (4% vs. 14%, P=0.22) were comparable between the groups. Two patients in the urgent group and 2 in the elective group had procedure-related nonlethal complications (7% vs. 6%, P=1.00): groin hematoma in 2, pressure ulcer in 1, and CO2 narcosis in 1. There were no in-hospital deaths, and mortality during follow-up did not differ between the urgent and elective groups (6.0% vs. 3.9% per year, log-rank P=0.38). Conclusion:Even in octogenarian patients, urgent catheter ablation for serious tachyarrhythmias can be safely performed with a high success rate and acceptable prognosis. (J Nippon Med Sch 2016; 83: 62 70)

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Urgent catheter ablation for sustained ventricular tachyarrhythmias in patients with acute heart failure decompensation

Abstract: Urgent RFCA for drug-resistant sustained ventricular tachyarrhythmias during AHF decompensations would be an appropriate therapeutic option. Purkinje fibres can be ablation targets not only in those with PVCs triggering VF, but also in those with monomorphic VT.

Cited by 15 publications

References 21 publications

Properties of screen printed electrocardiography smartware electrodes investigated in an electro-chemical cell

Properties of screen printed electrocardiography smartware electrodes investigated in an electro-chemical cell

Conversion to Purkinje-Related Monomorphic Ventricular Tachycardia After Ablation of Ventricular Fibrillation in Ischemic Heart Disease

Urgent Catheter Ablation in Octogenarians with Serious Tachyarrhythmias

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