Novel utility of cryoablation for ventricular arrhythmias arising from the left aortic cusp near the left main coronary artery

A case series

Kelly McDonnell, Edward Rhee, Komandoor Srivathsan, Wilber Su

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background Ablation of ventricular tachycardia and premature ventricular contraction arising at the aortic root has been described. The use of radiofrequency ablation energy has been associated with life-threatening collateral damage. The use of cryoablation as a safer alternative energy source at the aortic root has not been previously described. Objective To demonstrate that cautious cryoablation near the ostia of the left main coronary artery is technically feasible and is a safe, effective alternative energy source for ablation at the aortic root. Methods Six patients (mean age 36 years; 4 women) with refractory frequent premature ventricular contractions or ventricular tachycardia underwent electrophysiological study and ablation. Two patients had associated nonischemic cardiomyopathy. Patients' ventricular arrhythmias were localized by using 3D mapping, with arrhythmia foci being mapped to the left aortic cusp near the left main coronary artery. The proximity to the ostium of the left main coronary artery was confirmed by using intracardiac ultrasound and coronary angiogram. Focal ablation, up to 240 seconds with freeze-thaw-freeze cycles, was performed by using an 8-mm cryoablation catheter via a retrograde aortic approach. Results Termination of ventricular arrhythmia during ablation was observed in all 6 patients. All patients were followed for greater than 6-month postablation. One patient had acute ST-segment elevation during ablation below the left main ostium that resolved within 30 seconds of termination of ablation. There were no postprocedure complications and no significant arrhythmia recurrences. Conclusions Aortic root ventricular arrhythmia ablation carries an increased risk for collateral damages. This case series demonstrates that cautious cryoablation near the ostia of the left main coronary artery can be performed and is a safe, effective alternative energy source for ablation at the aortic root.

Original languageEnglish (US)
Pages (from-to)34-38
Number of pages5
JournalHeart Rhythm
Volume11
Issue number1
DOIs
StatePublished - Jan 1 2014

Fingerprint

Cryosurgery
Cardiac Arrhythmias
Coronary Vessels
Ventricular Premature Complexes
Ventricular Tachycardia
Cardiomyopathies
Angiography
Catheters
Recurrence

Keywords

  • Cardiac ablation
  • Cardiomyopathy
  • Cryothermy
  • Premature ventricular contractions
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Novel utility of cryoablation for ventricular arrhythmias arising from the left aortic cusp near the left main coronary artery : A case series. / McDonnell, Kelly; Rhee, Edward; Srivathsan, Komandoor; Su, Wilber.

In: Heart Rhythm, Vol. 11, No. 1, 01.01.2014, p. 34-38.

Research output: Contribution to journalArticle

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abstract = "Background Ablation of ventricular tachycardia and premature ventricular contraction arising at the aortic root has been described. The use of radiofrequency ablation energy has been associated with life-threatening collateral damage. The use of cryoablation as a safer alternative energy source at the aortic root has not been previously described. Objective To demonstrate that cautious cryoablation near the ostia of the left main coronary artery is technically feasible and is a safe, effective alternative energy source for ablation at the aortic root. Methods Six patients (mean age 36 years; 4 women) with refractory frequent premature ventricular contractions or ventricular tachycardia underwent electrophysiological study and ablation. Two patients had associated nonischemic cardiomyopathy. Patients' ventricular arrhythmias were localized by using 3D mapping, with arrhythmia foci being mapped to the left aortic cusp near the left main coronary artery. The proximity to the ostium of the left main coronary artery was confirmed by using intracardiac ultrasound and coronary angiogram. Focal ablation, up to 240 seconds with freeze-thaw-freeze cycles, was performed by using an 8-mm cryoablation catheter via a retrograde aortic approach. Results Termination of ventricular arrhythmia during ablation was observed in all 6 patients. All patients were followed for greater than 6-month postablation. One patient had acute ST-segment elevation during ablation below the left main ostium that resolved within 30 seconds of termination of ablation. There were no postprocedure complications and no significant arrhythmia recurrences. Conclusions Aortic root ventricular arrhythmia ablation carries an increased risk for collateral damages. This case series demonstrates that cautious cryoablation near the ostia of the left main coronary artery can be performed and is a safe, effective alternative energy source for ablation at the aortic root.",
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N2 - Background Ablation of ventricular tachycardia and premature ventricular contraction arising at the aortic root has been described. The use of radiofrequency ablation energy has been associated with life-threatening collateral damage. The use of cryoablation as a safer alternative energy source at the aortic root has not been previously described. Objective To demonstrate that cautious cryoablation near the ostia of the left main coronary artery is technically feasible and is a safe, effective alternative energy source for ablation at the aortic root. Methods Six patients (mean age 36 years; 4 women) with refractory frequent premature ventricular contractions or ventricular tachycardia underwent electrophysiological study and ablation. Two patients had associated nonischemic cardiomyopathy. Patients' ventricular arrhythmias were localized by using 3D mapping, with arrhythmia foci being mapped to the left aortic cusp near the left main coronary artery. The proximity to the ostium of the left main coronary artery was confirmed by using intracardiac ultrasound and coronary angiogram. Focal ablation, up to 240 seconds with freeze-thaw-freeze cycles, was performed by using an 8-mm cryoablation catheter via a retrograde aortic approach. Results Termination of ventricular arrhythmia during ablation was observed in all 6 patients. All patients were followed for greater than 6-month postablation. One patient had acute ST-segment elevation during ablation below the left main ostium that resolved within 30 seconds of termination of ablation. There were no postprocedure complications and no significant arrhythmia recurrences. Conclusions Aortic root ventricular arrhythmia ablation carries an increased risk for collateral damages. This case series demonstrates that cautious cryoablation near the ostia of the left main coronary artery can be performed and is a safe, effective alternative energy source for ablation at the aortic root.

AB - Background Ablation of ventricular tachycardia and premature ventricular contraction arising at the aortic root has been described. The use of radiofrequency ablation energy has been associated with life-threatening collateral damage. The use of cryoablation as a safer alternative energy source at the aortic root has not been previously described. Objective To demonstrate that cautious cryoablation near the ostia of the left main coronary artery is technically feasible and is a safe, effective alternative energy source for ablation at the aortic root. Methods Six patients (mean age 36 years; 4 women) with refractory frequent premature ventricular contractions or ventricular tachycardia underwent electrophysiological study and ablation. Two patients had associated nonischemic cardiomyopathy. Patients' ventricular arrhythmias were localized by using 3D mapping, with arrhythmia foci being mapped to the left aortic cusp near the left main coronary artery. The proximity to the ostium of the left main coronary artery was confirmed by using intracardiac ultrasound and coronary angiogram. Focal ablation, up to 240 seconds with freeze-thaw-freeze cycles, was performed by using an 8-mm cryoablation catheter via a retrograde aortic approach. Results Termination of ventricular arrhythmia during ablation was observed in all 6 patients. All patients were followed for greater than 6-month postablation. One patient had acute ST-segment elevation during ablation below the left main ostium that resolved within 30 seconds of termination of ablation. There were no postprocedure complications and no significant arrhythmia recurrences. Conclusions Aortic root ventricular arrhythmia ablation carries an increased risk for collateral damages. This case series demonstrates that cautious cryoablation near the ostia of the left main coronary artery can be performed and is a safe, effective alternative energy source for ablation at the aortic root.

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