| Long-term outcomes of combined epicardial and endocardial ablation of monomorphic ventricular tachycardia related to hypertrophic cardiomyopathy. | |
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MedLine Citation:
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PMID: 21270104 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Monomorphic ventricular tachycardia (MMVT) is rare in patients with hypertrophic cardiomyopathy (HCM). There are limited data on the utility of catheter ablation for the treatment of MMVT in this population. This study details a series of case reports from multiple centers where combined epicardial-endocardial ablation was performed in a highly selected group of patients with HCM-related MMVT. METHODS AND RESULTS: The cohort consisted of 10 patients with HCM-related MMVT. Pericardial access was achieved using the percutaneous subxyphoid approach. Epicardial and endocardial ventricular 3D bipolar voltage maps were generated. Ablation sites were identified using a combination of entrainment, activation, late/fractionated potential, and pace mapping. Electrophysiological-identified epicardial scar was present in 8 (80%) patients, endocardial scar in 6 (60%), and no scar in 1 (10%). In the 5 patients with inducible, stable MMVT, 3 cases were successfully terminated with ablation from the epicardium and 1 from the endocardium. The case that failed catheter ablation required surgical cryoablation to abolish the incessant VT. In the remaining 5 patients, 4 underwent epicardial and endocardial ablation of sites with good pace maps and late/fractionated potentials. No ablation was performed in the remaining patient because of noninducibility and lack of identifiable scar. After 37±17 months (limits, 2 to 62 months; median, 37 months), the freedom from recurrent implantable cardioverter-defibrillator shocks was 78% (7/9 patients) in those who underwent ablation. CONCLUSIONS: In highly selected patients with HCM, combined epicardial and endocardial mapping and ablation is a feasible and reasonably efficacious option for MMVT if refractory to aggressive trials of antiarrhythmic drugs and antitachycardia pacing. |
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Authors:
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Srinivas R Dukkipati; Andre d'Avila; Kyoko Soejima; Rupa Bala; Keiichi Inada; Sheldon Singh; William G Stevenson; Francis E Marchlinski; Vivek Y Reddy |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't Date: 2011-01-26 |
Journal Detail:
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Title: Circulation. Arrhythmia and electrophysiology Volume: 4 ISSN: 1941-3084 ISO Abbreviation: Circ Arrhythm Electrophysiol Publication Date: 2011 Apr |
Date Detail:
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Created Date: 2011-04-20 Completed Date: 2011-06-17 Revised Date: 2012-02-03 |
Medline Journal Info:
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Nlm Unique ID: 101474365 Medline TA: Circ Arrhythm Electrophysiol Country: United States |
Other Details:
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Languages: eng Pagination: 185-94 Citation Subset: IM |
Affiliation:
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Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Anti-Arrhythmia Agents Cardiomyopathy, Hypertrophic / complications*, physiopathology Catheter Ablation / methods* Cryosurgery Defibrillators, Implantable Electric Countershock / instrumentation Electrophysiologic Techniques, Cardiac Endocardium / physiopathology, surgery* Humans Imaging, Three-Dimensional Japan Male Middle Aged Pericardium / physiopathology, surgery* Recurrence Reoperation Tachycardia, Ventricular / etiology, physiopathology, surgery* Time Factors Treatment Outcome United States |
| Chemical | |
Reg. No./Substance:
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0/Anti-Arrhythmia Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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