II Medizinische Abteilung, Asklepios Klinik St. Georg, Hamburg, Germany.
Published: August 2012
AI Article Synopsis
Article Abstract
Background: The requirement for epicardial radiofrequency ablation (RFA) is still undefined in ventricular tachycardia (VT) late after myocardial infarction (MI).
Objective: The purpose of this study was to evaluate the correlation between the need for epicardial RFA and the clinical and electrophysiologic characteristics of VT late after MI.
Methods: Endocardial mapping and RFA were performed for VT late after MI, followed by epicardial mapping and RFA if no endocardial substrate was present or endocardial RFA failed.
Results: Seventy patients with VT late after MI (30 anterior MI [A-MI] and 40 posteroinferior MI [PI-MI]) were included in the study. Forty-one VTs in patients with A-MI and 64 VTs in patients with PI-MI were targeted for RFA. Epicardial mapping and ablation were attempted in 6 patients and performed successfully in only 4 patients. All 6 (100%) patients requiring epicardial access had PI-MIs. Patients with epicardial RFA had endocardial low-voltage areas of smaller size compared to patients without epicardial RFA (21 ± 13 cm(2) vs 68 ± 40 cm(2); P <.01). During 25 ± 19 months of follow-up, recurrence after the initial procedure was noted in 12 of 30 patients (40%) with A-MI and in 18 of 40 patients (45%) with PI-MI. There was no significant difference between groups.
Conclusion: In the majority of patients, clinical and slower VTs late after MI can be abolished using endocardial RFA. Rarely indicated, epicardial RFA is more commonly required in patients with small-sized PI-MI. During follow-up, VT recurrence after successful RFA is common.
Background: Reconnection of the mitral isthmus (MI) is common after radiofrequency ablation (RFA). Vein of Marshall ethanol infusion (VOMEI) expedites MI ablation, but long-term results are unclear.
Objectives: This study sought to determine anatomic substrates of failed MI ablation, with and without VOMEI.
Introduction And Importance: Atrial tachycardias (AT) originating from the Marshall bundle (MB) are rare and present significant challenges in diagnosis and management. The authors present the case of a 29-year-old male with recurrent AT successfully treated with a combined ethanol and radiofrequency ablation approach. This case highlights the effectiveness of this dual ablation strategy in resolving AT originating from the MB, contributing valuable insights into managing complex AT cases.
Background: Comparative efficacy and safety data on radiofrequency ablation (RFA) versus pulsed field ablation (PFA) for common idiopathic left ventricular arrhythmia (LV-VAs) locations are lacking.
Objectives: This study sough to compare RFA with PFA of common idiopathic LV-VAs locations.
Methods: Ten swine were randomized to PFA or RFA of LV interventricular septum, papillary muscle, LV summit via distal coronary sinus, and LV epicardium via subxiphoid approach.
Background: Bipolar radiofrequency ablation (B-RFA) is a method used to treat the arrhythmia substrate resistant to unipolar ablation. Few studies have addressed endo-epicardial B-RFA.
Objective: The aim of the study was to evaluate chronic lesions resulting from endo-epicardial B-RFA and to determine optimal settings for such procedures in an animal model.
Introduction: With the entry of pulsed-field ablation (PFA) into electrophysiology, new possibilities for ablation of different substrates such as epicardial foci of premature ventricular contractions (PVCs) from coronary venous system (CVS) have been opened.
Methods: This article focuses on a case of a 27-year-old patient with frequent monomorphic PVCs of epicardial origin, treated by radiofrequency ablation, followed by PFA.
Results: After unsuccessful focus ablation through CVS with RFA, successful ablations from the same region with PFA were achieved.
