Endocardial Ablation to Eliminate Epicardial Arrhythmia Substrate in Scar-Related Ventricular Tachycardia

Komatsu, Yuki; Daly, Matthew; Sacher, Frédéric; Cochet, Hubert; Denis, Arnaud; Derval, Nicolas; Jesel, Laurence; Zellerhoff, Stephan; Lim, Han S; Jadidi, Amir; Nault, Isabelle; Shah, Ashok; Roten, Laurent; Pascale, Patrizio; Scherr, Daniel; Aurillac-Lavignolle, Valerie; Hocini, Mélèze; Haïssaguerre, Michel; Jaïs, Pierre (2014). Endocardial Ablation to Eliminate Epicardial Arrhythmia Substrate in Scar-Related Ventricular Tachycardia. Journal of the American College of Cardiology, 63(14), pp. 1416-1426. Elsevier 10.1016/j.jacc.2013.10.087

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OBJECTIVES

We evaluated the feasibility and safety of epicardial substrate elimination using endocardial radiofrequency (RF) delivery in patients with scar-related ventricular tachycardia (VT).

BACKGROUND

Epicardial RF delivery is limited by fat or associated with bleeding, extra-cardiac damages, coronary vessels and phrenic nerve injury. Alternative ablation approaches may be desirable.

METHODS

Forty-six patients (18 ischemic cardiomyopathy [ICM], 13 non-ischemic dilated cardiomyopathy [NICM], 15 arrhythmogenic right ventricular cardiomyopathy [ARVC]) with sustained VT underwent combined endo- and epicardial mapping. All patients received endocardial ablation targeting local abnormal ventricular activities in the endocardium (Endo-LAVA) and epicardium (Epi-LAVA), followed by epicardial ablation if needed.

RESULTS

From a total of 173 endocardial ablations targeting Epi-LAVA at the facing site, 48 (28%) applications (ICM: 20/71 [28%], NICM: 3/39 [8%], ARVC: 25/63 [40%]) successfully eliminated the Epi-LAVA. Presence of Endo-LAVA, most delayed and low bipolar amplitude of Epi-LAVA, low unipolar amplitude in the facing endocardium, and Epi-LAVA within a wall thinning area at CT scan were associated with successful ablation. Endocardial ablation could abolish all Epi-LAVA in 4 ICM and 2 ARVC patients, whereas all patients with NICM required epicardial ablation. Endocardial ablation was able to eliminate Epi-LAVA at least partially in 15 (83%) ICM, 2 (13%) NICM, and 11 (73%) ARVC patients, contributing to a potential reduction in epicardial RF applications. Pericardial bleeding occurred in 4 patients with epicardial ablation.

CONCLUSIONS

Elimination of Epi-LAVA using endocardial RF delivery is feasible and may be used first to reduce the risk of epicardial ablation.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
UniBE Contributor:	Roten, Laurent
Subjects:	600 Technology > 610 Medicine & health
ISSN:	0735-1097
Publisher:	Elsevier
Language:	English
Submitter:	Laurent Roten
Date Deposited:	10 Oct 2014 16:37
Last Modified:	05 Dec 2022 14:28
Publisher DOI:	10.1016/j.jacc.2013.10.087
PubMed ID:	24486269
Uncontrolled Keywords:	ARVC, ICD, ICM, LAVA, LV, MDCT, NICM, RF, VT, ablation, arrhythmia, arrhythmogenic, right ventricular cardiomyopathy, epicardium, implantable cardioverter, defibrillator, ischemic cardiomyopathy, left ventricle, local abnormal ventricular activities, multi-detector computed tomography, non-ischemic dilated cardiomyopathy, radiofrequency, ventricular tachycardia
URI:	https://boris.unibe.ch/id/eprint/42239