Publications by authors named "Erica Zado"
Background: Patients undergoing first-time atrial fibrillation (AF) ablation can benefit from targeting non-pulmonary vein (PV) triggers. Preprocedural identification of high-risk individuals can guide planning of ablation strategy. This study aimed to create a preprocedural screening tool to identify patients at risk of non-PV triggers during first-time AF ablation.
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- The study investigates the long-term risk of damage to the right coronary artery (RCA) after patients undergo radiofrequency ablation (RFA) for atrial flutter related to the cavotricuspid isthmus (CTI).
- A comparison was made between patients who had CTI RFA and those who only received ablation for atrial fibrillation (AF), with coronary angiography performed afterward to evaluate any differences in RCA stenosis.
- Results indicate that there were no significant differences in the incidence or severity of RCA stenoses between the two groups, suggesting that CTI RFA does not increase the risk of RCA damage in the long term.
Background: The importance of nonpulmonary vein (PV) triggers for the initiation/recurrence of atrial fibrillation (AF) is well established.
Objectives: This study sought to assess the incremental benefit of provocative maneuvers for identifying non-PV triggers.
Methods: We included consecutive patients undergoing first-time AF ablation between 2020 and 2022.
Article Synopsis
- Right phrenic nerve (RPN) injury is a rare but serious complication during atrial fibrillation radiofrequency ablation, and this study seeks to understand the relationship between pacing sites and actual RPN anatomy.
- Researchers conducted a study involving 45 patients to map the RPN's course using high-output pacing and CT scans, analyzing data from 1,033 pacing sites.
- The findings indicate that non-capture at high pacing thresholds is a reliable predictor of being more than 10mm away from the RPN, which helps ensure safer radiofrequency ablation procedures.
Introduction: Identifying the origin of nonpulmonary vein atrial fibrillation (AF) triggers (NPVTs) after pulmonary vein isolation (PVI) can be challenging. We aimed to determine if noninvasive electrocardiographic imaging (ECGi) could localize pacing from common NPVT sites. ECGi combines measured body surface potentials with heart-torso geometry acquired from computed tomography (CT) to generate an activation map.
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- The study examines the effectiveness of endocardial (ENDO) ablation in treating arrhythmogenic right ventricular cardiomyopathy (ARVC), specifically focusing on its long-term outcomes and factors influencing survival without ventricular tachycardia (VT).
- A total of 74 patients with ARVC underwent ENDO-only VT ablation between 1998 and 2020, with about 66% achieving noninducibility of VT and a median follow-up of 6.6 years revealing that over 54% remained free of VT recurrence.
- Important predictors for long-term VT-free survival included being over 45 years at diagnosis and achieving VT noninducibility, suggesting that ENDO-only ablation could be a viable initial
Article Synopsis
- Epicardial access is important during ventricular tachycardia ablation, and the study compares two methods: traditional ConvEpi access and a newer method called EpiCO, which involves puncturing coronary venous branches.
- The study included 153 patients and found that both methods had similar success rates, but ConvEpi was quicker and associated with more complications, especially significant bleeding.
- Overall, EpiCO access showed a decrease in major complications and bleeding compared to ConvEpi, suggesting it might be a safer option for patients.
Background: Targeting non-pulmonary vein triggers (NPVTs) after pulmonary vein isolation may reduce atrial fibrillation (AF) recurrence. Isoproterenol infusion and cardioversion of spontaneous or induced AF can provoke NPVTs but typically require vasopressor support and increased procedural time.
Objective: The purpose of this study was to identify risk factors for the presence of NPVTs and create a risk score to identify higher-risk subgroups.
Article Synopsis
- A study on arrhythmogenic right ventricular cardiomyopathy (ARVC) found that a significant number of patients (34%) experienced atrial arrhythmias (AAs) even after undergoing ventricular tachycardia (VT) ablation.
- The most common types of AAs were atrial fibrillation, typical atrial flutter, and atypical flutter, with many patients requiring further ablation procedures to manage these issues effectively.
- A risk score was developed to predict the likelihood of typical atrial flutter, which can help identify patients who might benefit from specific interventions during VT ablation.
Background: Targeting nonpulmonary vein triggers (NPVTs) of atrial fibrillation (AF) after pulmonary vein isolation can be challenging. NPVTs are often single ectopic beats with a surface P-wave obscured by a QRS or T-wave.
Objectives: The goal of this study was to construct an algorithm to regionalize the site of origin of NPVTs using only intracardiac bipolar electrograms from 2 linear decapolar catheters positioned in the posterolateral right atrium (along the crista terminalis with the distal bipole pair in the superior vena cava) and in the proximal coronary sinus (CS).
Article Synopsis
- Entrainment and standard pacing techniques are often ineffective in identifying critical components of ventricular tachycardia (VT) in patients with dense myocardial scarring.
- This study evaluated the effectiveness of very high-output pacing (V-HOP), which uses higher power (50 mA) to stimulate heart tissue, for locating these critical areas when standard methods failed.
- Results showed V-HOP successfully identified critical components in most patients and guided effective ablation procedures, leading to a high success rate without serious complications.
Background: Ventricular fibrillation (VF) can be initiated by ventricular premature depolarizations (VPDs) in the absence of obvious structural abnormalities.
Objective: The purpose of this study was to determine the prevalence of 12-lead electrocardiographic (ECG) sinus rhythm reduced QRS amplitude, QRS fractionation (QRSf), and early repolarization (ER) pattern, and the outcome of catheter ablation and VPD anatomic distribution in patients with VPDs initiating VF.
Methods: We compared a cohort with no apparent structural heart disease and VPDs initiating VF (group 1; n = 42) to a reference cohort (group 2; n = 61) of patients with no structural heart disease and symptomatic unifocal VPDs.
Impact of Left Ventricular Papillary Muscle Ventricular Arrhythmia Ablation on Mitral Valve Function.
JACC Clin Electrophysiol
December 2022
Article Synopsis
- Catheter ablation of ventricular arrhythmias from left ventricular papillary muscles can impact mitral valve function, which prompted this study to investigate the effects of lesions on mitral valve performance.
- The study analyzed 103 patients from 2015 to 2020, assessing mitral valve regurgitation before and after radiofrequency ablation using echocardiograms.
- Results showed that 99% of patients experienced no significant changes in mitral valve function post-procedure, indicating that the ablation can be performed safely without negatively affecting the mitral valve.
Article Synopsis
- The study investigates the impact of having sinus rhythm (SR) at the time of catheter ablation (CA) on long-term outcomes for patients with persistent atrial fibrillation (PersAF).
- Results show that patients who presented in SR had better freedom from atrial arrhythmias (AAs) after the procedure compared to those who presented in atrial fibrillation (AF).
- The findings suggest that achieving SR before ablation can improve overall arrhythmia outcomes and prolong the time until recurrent AF.
Article Synopsis
- This study examined whether using prolonged duration (PD) radiofrequency ablation (RFA) can enhance the outcomes of catheter ablation (CA) for left ventricular summit (LVS) ventricular arrhythmias (VAs).
- The research included 102 patients over four years, comparing standard RFA to PD RFA, with results showing higher procedural success and clinical outcomes with PD RFA.
- The findings suggest that PD RFA is a safe and effective approach for treating difficult LVS VAs that do not respond to standard RFA techniques.
Background: Ventricular tachycardia (VT) substrate abnormalities in arrhythmogenic right ventricular cardiomyopathy (ARVC) typically involve both the right ventricular (RV) endocardium (ENDO) and epicardium (EPI).
Objective: The purpose of this study was to examine the prevalence, electrophysiological features, and outcomes of catheter ablation of VT in patients with isolated epicardial substrate (IES) abnormalities.
Methods: We studied 71 consecutive patients with VT who met Task Force criteria for ARVC and underwent detailed ENDO and EPI mapping.
Article Synopsis
- The study focused on patients with left ventricular nonischemic cardiomyopathy experiencing ventricular tachycardia (VT), highlighting that the abnormal electrical activity often occurs primarily on the epicardial surface.
- Researchers found that among the 47 assessed patients, there was a significant prevalence of abnormal epicardial low-voltage areas, with the most common location being the basal inferolateral region of the left ventricle.
- The results indicated that patients who underwent ablation targeting epicardial VT had promising long-term outcomes, but those with larger endocardial low-voltage areas and more recurrent VT episodes faced higher risks of VT recurrence.
Background: Ventricular tachycardia (VT) substrate in left ventricular (LV) nonischemic cardiomyopathy (NICM) consists of fibrosis with surviving myocardium.
Objective: The purpose of this study was to determine whether, in patients with LV NICM and sustained VT, reduced QRS amplitude and QRSf during sinus rhythm can identify the presence and location of abnormal septal (S-NICM) and/or free-wall (FW-NICM) VT substrate.
Methods: We compared patients with NICM and VT (group 1) with electroanatomic mapping septal (S-NICM; n = 21) or free-wall (FW-NICM; n = 20) VT substrate to a 38-patient reference cohort (group 2) with cardiac magnetic resonance imaging (cMRI) and NICM but no VT referred for primary prevention implantable cardioverter-defibrillator (26 [68.
Background: Interatrial septal tachycardias (IAS-ATs) following atrial fibrillation (AF) ablation or cardiac surgery are rare, and their management is challenging.
Objective: The purpose of this study was to investigate the electrophysiological features and outcomes associated with catheter ablation of IAS-AT.
Methods: We screened 338 patients undergoing catheter ablation of ATs following AF ablation or cardiac surgery.
Objectives: This study sought to examine the impact of periprocedural acute kidney injury (AKI) in scar-related ventricular tachycardia (VT) patients undergoing radiofrequency catheter ablation (RFCA) on short- and long-term outcomes.
Background: The clinical significance of periprocedural AKI in patients with scar-related VT undergoing RFCA has not been previously investigated.
Methods: This study included 317 consecutive patients with scar-related VT undergoing RFCA (age: 64 ± 13 years, mean left ventricular ejection fraction: 33 ± 13%, 55% ischemic cardiomyopathy).