Catheter ablation of short-coupled variant of torsade de pointes

Steinfurt, Johannes; Nazer, Babak; Aguilar, Martin; Moss, Joshua; Higuchi, Satoshi; Zarse, Markus; Trolese, Luca; Gressler, Alexander; Faber, Thomas S.; Odening, Katja E; Zehender, Manfred; Bode, Christoph; Scheinman, Melvin M.; Tedrow, Usha B.; Bogossian, Harilaos (2022). Catheter ablation of short-coupled variant of torsade de pointes. Clinical research in cardiology, 111(5), pp. 502-510. Springer-Verlag 10.1007/s00392-021-01840-z

Preview

Text Steinfurt2021CatheterAb.pdf - Published Version Available under License Creative Commons: Attribution (CC-BY). Download (2MB) | Preview

Background: The short-coupled variant of torsade de pointes (sc-TdP) is a malignant arrhythmia that frequently presents with ventricular fibrillation (VF) electrical storm. Verapamil is considered the first-line therapy of sc-TdP while catheter ablation is not widely adopted. The aim of this study was to determine the origin of sc-TdP and to assess the outcome of catheter ablation using 3D-mapping.

Methods and results: We retrospectively analyzed five patients with sc-TdP who underwent 3D-mapping and ablation of sc-TdP at five different institutions. Four patients initially presented with sudden cardiac arrest, one patient experienced recurrent syncope as the first manifestation. All patients demonstrated a monomorphic premature ventricular contraction (PVC) with late transition left bundle branch block pattern, superior axis, and a coupling interval of less than 300 ms. triggering recurrent TdP and VF. In four patients, the culprit PVC was mapped to the free wall insertion of the moderator band (MB) with a preceding Purkinje potential in two patients. Catheter ablation using 3D-mapping and intracardiac echocardiography eliminated sc-TdP in all patients, with no recurrence at mean 2.7 years (range 6 months to 8 years) of follow-up.

Conclusion: 3D-mapping and intracardiac echocardiography demonstrate that sc-TdP predominantly originates from the MB free wall insertion and its Purkinje network. Catheter ablation of the culprit PVC at the MB free wall junction leads to excellent short- and long-term results and should be considered as first-line therapy in recurrent sc-TdP or electrical storm.

Interest & Impact

Downloads

40 since deposited on 17 Jan 2022
32 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item