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Ventricular Arrhythmias near the Distal Great Cardiac Vein: A Challenging Arrhythmia for Ablation.
MedLine Citation:
PMID:  25110163     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: -Catheter ablation (CA) for ventricular arrhythmia (VA) near the distal great cardiac vein (GCV) is often challenging and data are limited.
METHODS AND RESULTS: -Analysis was performed of 30 patients (19 male; age 52.8±15.5 years) who underwent CA for focal VA (11 ventricular tachycardia, 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-nonGCV interval). In 13 patients percutaneous epicardial mapping was performed, but due to 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-nonGCV interval and r wave in lead I.
Authors:
Koichi Nagashima; Eue-Keun Choi; Kaity Y Lin; Saurabh Kumar; Usha B Tedrow; Bruce A Koplan; Gregory F Michaud; Roy M John; Laurence M Epstein; Michifumi Tokuda; Keiichi Inada; Gregory S Couper; William G Stevenson
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-8-10
Journal Detail:
Title:  Circulation. Arrhythmia and electrophysiology     Volume:  -     ISSN:  1941-3084     ISO Abbreviation:  Circ Arrhythm Electrophysiol     Publication Date:  2014 Aug 
Date Detail:
Created Date:  2014-8-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101474365     Medline TA:  Circ Arrhythm Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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