Relevance of endocavitary structures in ablation procedures for ventricular tachycardia

Omar Abou Ezzeddine, Mahmoud Suleiman, Traci Buescher, Suraj Kapa, Paul Andrew Friedman, Arshad Jahangir, Jennifer A. Mears, Dorothy J. Ladewig, Thomas M. Munger, Stephen C. Hammill, Douglas L Packer, Samuel J Asirvatham

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Endocavitary Structures and Ventricular Tachycardia Ablation. Background: Radiofrequency (RF) ablation for ventricular tachycardia (VT) has high failure rates. Whether endocavitary structures (ECS) such as the papillary muscles (PMs), moderator bands (MBs), or false tendons (FTs) impact VT ablation is unknown. Methods and Results: We retrospectively reviewed records of 190 consecutive patients presenting for VT ablation and identified 46 (24%) where ECS affected ablation. In 31 of 46 patients (67%), the ECS created difficulty with catheter manipulation (n = 20), interpretation of pace map data (n = 7), or with accurately defining a scar (n = 4). In 15 of 46 (33%), specific mapping and RF energy delivery targeting the ECS itself was necessary to eliminate the arrhythmia. Detailed electroanatomic mapping was performed in 11 of 15 (73%), noncontact mapping in 3 of 15 (20%), multielectrode catheter mapping in 1 of 15 (7%), and intracardiac ultrasound in 14 of 15 (93%) patients. The ablated ECS was a PM in 5 of 15, the MB in 7 of 15, and an FT in 3 of 15. The arrhythmogenic substrate on the ECS was a focus of automatic tachycardia in 9 of 15 and the slow zone responsible for reentrant arrhythmia in the remaining 6 of 15. Successful elimination of tachycardia without recurrence was obtained in all 15 cases. There was no evidence of valvular damage or disruption of the valvular apparatus. Conclusion: During VT ablation procedures, ECS should be considered for specific mapping and targeted ablation. Once recognized, these structures can be successfully targeted for ablation without valve damage.

Original languageEnglish (US)
Pages (from-to)245-254
Number of pages10
JournalJournal of Cardiovascular Electrophysiology
Volume21
Issue number3
DOIs
StatePublished - Mar 2010

Fingerprint

Ventricular Tachycardia
Papillary Muscles
Tachycardia
Tendons
Cardiac Arrhythmias
Catheters
Cicatrix
Recurrence

Keywords

  • Catheter ablation
  • False tendon (FT)
  • Moderator band (MB)
  • Papillary muscle (PM)
  • Ventricular tachycardia (VT)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Relevance of endocavitary structures in ablation procedures for ventricular tachycardia. / Abou Ezzeddine, Omar; Suleiman, Mahmoud; Buescher, Traci; Kapa, Suraj; Friedman, Paul Andrew; Jahangir, Arshad; Mears, Jennifer A.; Ladewig, Dorothy J.; Munger, Thomas M.; Hammill, Stephen C.; Packer, Douglas L; Asirvatham, Samuel J.

In: Journal of Cardiovascular Electrophysiology, Vol. 21, No. 3, 03.2010, p. 245-254.

Research output: Contribution to journalArticle

Abou Ezzeddine, Omar ; Suleiman, Mahmoud ; Buescher, Traci ; Kapa, Suraj ; Friedman, Paul Andrew ; Jahangir, Arshad ; Mears, Jennifer A. ; Ladewig, Dorothy J. ; Munger, Thomas M. ; Hammill, Stephen C. ; Packer, Douglas L ; Asirvatham, Samuel J. / Relevance of endocavitary structures in ablation procedures for ventricular tachycardia. In: Journal of Cardiovascular Electrophysiology. 2010 ; Vol. 21, No. 3. pp. 245-254.
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abstract = "Endocavitary Structures and Ventricular Tachycardia Ablation. Background: Radiofrequency (RF) ablation for ventricular tachycardia (VT) has high failure rates. Whether endocavitary structures (ECS) such as the papillary muscles (PMs), moderator bands (MBs), or false tendons (FTs) impact VT ablation is unknown. Methods and Results: We retrospectively reviewed records of 190 consecutive patients presenting for VT ablation and identified 46 (24{\%}) where ECS affected ablation. In 31 of 46 patients (67{\%}), the ECS created difficulty with catheter manipulation (n = 20), interpretation of pace map data (n = 7), or with accurately defining a scar (n = 4). In 15 of 46 (33{\%}), specific mapping and RF energy delivery targeting the ECS itself was necessary to eliminate the arrhythmia. Detailed electroanatomic mapping was performed in 11 of 15 (73{\%}), noncontact mapping in 3 of 15 (20{\%}), multielectrode catheter mapping in 1 of 15 (7{\%}), and intracardiac ultrasound in 14 of 15 (93{\%}) patients. The ablated ECS was a PM in 5 of 15, the MB in 7 of 15, and an FT in 3 of 15. The arrhythmogenic substrate on the ECS was a focus of automatic tachycardia in 9 of 15 and the slow zone responsible for reentrant arrhythmia in the remaining 6 of 15. Successful elimination of tachycardia without recurrence was obtained in all 15 cases. There was no evidence of valvular damage or disruption of the valvular apparatus. Conclusion: During VT ablation procedures, ECS should be considered for specific mapping and targeted ablation. Once recognized, these structures can be successfully targeted for ablation without valve damage.",
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AU - Suleiman, Mahmoud

AU - Buescher, Traci

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AU - Friedman, Paul Andrew

AU - Jahangir, Arshad

AU - Mears, Jennifer A.

AU - Ladewig, Dorothy J.

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AB - Endocavitary Structures and Ventricular Tachycardia Ablation. Background: Radiofrequency (RF) ablation for ventricular tachycardia (VT) has high failure rates. Whether endocavitary structures (ECS) such as the papillary muscles (PMs), moderator bands (MBs), or false tendons (FTs) impact VT ablation is unknown. Methods and Results: We retrospectively reviewed records of 190 consecutive patients presenting for VT ablation and identified 46 (24%) where ECS affected ablation. In 31 of 46 patients (67%), the ECS created difficulty with catheter manipulation (n = 20), interpretation of pace map data (n = 7), or with accurately defining a scar (n = 4). In 15 of 46 (33%), specific mapping and RF energy delivery targeting the ECS itself was necessary to eliminate the arrhythmia. Detailed electroanatomic mapping was performed in 11 of 15 (73%), noncontact mapping in 3 of 15 (20%), multielectrode catheter mapping in 1 of 15 (7%), and intracardiac ultrasound in 14 of 15 (93%) patients. The ablated ECS was a PM in 5 of 15, the MB in 7 of 15, and an FT in 3 of 15. The arrhythmogenic substrate on the ECS was a focus of automatic tachycardia in 9 of 15 and the slow zone responsible for reentrant arrhythmia in the remaining 6 of 15. Successful elimination of tachycardia without recurrence was obtained in all 15 cases. There was no evidence of valvular damage or disruption of the valvular apparatus. Conclusion: During VT ablation procedures, ECS should be considered for specific mapping and targeted ablation. Once recognized, these structures can be successfully targeted for ablation without valve damage.

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KW - False tendon (FT)

KW - Moderator band (MB)

KW - Papillary muscle (PM)

KW - Ventricular tachycardia (VT)

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