Surgical cryoablation for ventricular tachyarrhythmia arising from the left ventricular outflow tract region.

Choi, Eue-Keun; Nagashima, Koichi; Lin, Kaity Y; Kumar, Saurabh; Barbhaiya, Chirag R; Baldinger, Samuel Hannes; Reichlin, Tobias; Michaud, Gregory F; Couper, Gregory S; Stevenson, William G; John, Roy M (2015). Surgical cryoablation for ventricular tachyarrhythmia arising from the left ventricular outflow tract region. Heart rhythm, 12(6), pp. 1128-1136. Elsevier 10.1016/j.hrthm.2015.02.016

[img] Text
1-s2.0-S1547527115001952-main.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (4MB)

BACKGROUND

Ventricular arrhythmias (VAs) from the left ventricular outflow tract (LVOT) region can be inaccessible for ablation because of epicardial fat or overlying coronary arteries.

OBJECTIVE

We describe surgical cryoablation of this type of VA.

METHODS

From March 2009 to 2014, 190 consecutive patients with VAs originating from the LVOT underwent ablation at our institution. Four patients (2%) underwent surgical cryoablation for highly symptomatic VAs after failing catheter ablation.

RESULTS

In all patients, endocardial or percutaneous epicardial mapping was consistent with origin in the LVOT. In 2 patients, the points of earliest activation during VAs were marked with a bipolar pacing lead in the overlying cardiac vein for guidance during surgery. Surgical cryoablation was successful in 3 of the 4 patients. The fourth patient subsequently had successful endocardial catheter ablation. During a mean follow-up of 22 ± 16 months (range 4-42 months), all patients showed abolition of or marked reduction in symptomatic VA. However, 1 patient subsequently required percutaneous intervention to the left anterior descending coronary artery; another developed progressive left ventricular systolic dysfunction caused by nonischemic cardiomyopathy; and a third patient underwent permanent pacemaker implantation because of complete atrioventricular block after concomitant aortic valve replacement.

CONCLUSION

Surgical cryoablation is an option for highly symptomatic drug-resistant VAs emanating from the LVOT region. Despite extensive preoperative mapping, the procedure is not effective for all patients, and coronary injury is a risk.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Baldinger, Samuel Hannes

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1547-5271

Publisher:

Elsevier

Language:

English

Submitter:

Samuel Hannes Baldinger

Date Deposited:

30 Jun 2016 10:17

Last Modified:

05 Dec 2022 14:56

Publisher DOI:

10.1016/j.hrthm.2015.02.016

PubMed ID:

25697752

Uncontrolled Keywords:

Left ventricular outflow tract; Surgical cryoablation; Ventricular tachycardia; Ventricular tachycardia ablation

BORIS DOI:

10.7892/boris.83893

URI:

https://boris.unibe.ch/id/eprint/83893

Actions (login required)

Edit item Edit item
Provide Feedback