Document Detail


Long-term outcomes of combined epicardial and endocardial ablation of monomorphic ventricular tachycardia related to hypertrophic cardiomyopathy.
MedLine Citation:
PMID:  21270104     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2011-01-26
Journal Detail:
Title:  Circulation. Arrhythmia and electrophysiology     Volume:  4     ISSN:  1941-3084     ISO Abbreviation:  Circ Arrhythm Electrophysiol     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-04-20     Completed Date:  2011-06-17     Revised Date:  2012-02-03    
Medline Journal Info:
Nlm Unique ID:  101474365     Medline TA:  Circ Arrhythm Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  185-94     Citation Subset:  IM    
Affiliation:
Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY, USA.
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MeSH Terms
Descriptor/Qualifier:
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:
0/Anti-Arrhythmia Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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