Ablation of ventricular arrhythmias
Ever D. Grech in Practical Interventional Cardiology, 2017
Complications of catheter ablation of VAs include damage to valves, cardiac perforation resulting in pericardial effusion and tamponade, complications related to vascular access, complete AV block, myocardial infarction and stroke. Procedural mortality ranges from 0% to 3%.23 Acute haemodynamic decompensation may occur in 11% of the patients.24 Close attention should be paid to the volume of saline delivered by the open-irrigated catheter as many patients have congestive heart failure. Diuretics are useful both during and after the procedure to balance the fluid administration from the catheters and infusions. Using an epicardial approach, additional complications may include damage to the coronary vasculature, left phrenic nerve palsy or accidental puncture of nearby non-cardiac structures during epicardial access.
Minimally Invasive Atrial Ablation Surgery
Theo Kofidis in Minimally Invasive Cardiac Surgery, 2021
The advances in technology since the original maze procedure have facilitated the expansion of a minimally invasive surgical option to many patients with non-paroxysmal AF. Yet despite these advances, none approach the low level of invasiveness of catheter ablation. To evaluate the differences in catheter and surgical ablation for AF, Boersma et al. compared the efficacy and safety of catheter ablation and minimally invasive surgical ablation in 124 patients with drug-refractory AF, left atrial dilatation (>4 cm) and hypertension [22]. AF was paroxysmal (67%), persistent (33%) or long-standing persistent (8%). The surgical ablation consisted of the Dallas lesion set as described by Edgerton. Catheter ablation consisted of wide-area linear antrum ablation with PV isolation guided by circular mapping catheter. Additional lines were made at the discretion of the operator. Patients were followed with ECG and 7-day Holter monitoring at 6 and 12 months. The median length of stay was 5.5 days vs 2 days for surgical or catheter ablation, respectively.
Deaths Following Cardiac Surgery and Invasive Interventions
Mary N. Sheppard in Practical Cardiovascular Pathology, 2022
Atrial fibrillation (AF) is very common in the ageing population. Current therapy for AF includes drug therapy, catheter ablation, cryoballoon ablation, left atrial appendage closure and the maze procedure. Depending on the arrhythmia, catheter ablation is a treatment option at initial diagnosis, or if medical therapy fails. Catheter ablation of supraventricular tachycardias, atrial flutter and AF offers patients high effectiveness rates and permanent results with low complication rates. Ablations are performed worldwide using different energy sources. One of the most popular methods is radiofrequency catheter ablation and isolation of the pulmonary veins via a transseptal approach. Complications associated with catheter ablation result from radiation exposure, vascular access (e.g. haematomas, cardiac perforation with tamponade), catheter manipulation (e.g. cardiac perforation with tamponade, thromboembolic events) or ablation energy delivery (e.g. atrioventricular nodal block).9 Recent ablation sites can be observed in the atrium around the pulmonary veins as irregular haemorrhagic foci on the subendocardium (Fig. 9.9) and pericardium (Fig. 9.10). Sections at ablation sites show haemorrhagic necrosis with surrounding granulation tissue within the left atrium and pulmonary vein wall (Fig. 9.11). Rarely repeated right atrial ablation close to the mouth of inferior vena cava may lead to vein rupture (Fig. 9.12). Atrial and oesophageal perforation can also occur with left atrial ablation (Fig. 9.13). With the increased use of catheter-based ablation for the treatment of AF with pulmonary vein isolation via a transseptal approach (Fig. 9.14), pulmonary vein stenosis is becoming more common.
Mexiletine for ventricular arrhythmias in patients with chronic coronary syndrome: a cohort study
Published in Acta Cardiologica, 2022
Giacomo Mugnai, Carla Paolini, Stefano Cavedon, Alessandro Mecenero, Cosimo Perrone, Claudio Bilato
Previous studies have already proven that catheter ablation is able to reduce the rate of ventricular arrhythmias, especially in patients with coronary artery disease. Sapp et al. [8] conducted a multicenter, randomised, controlled trial (VANISH) involving 259 ICD patients with ischaemic cardiomyopathy and refractory ventricular arrhythmias unresponsive to antiarrhythmic drugs. Patients were randomly assigned to receive either catheter ablation or escalated antiarrhythmic drug therapy. During a mean follow-up time of 27.9 ± 17.1 months, the composite primary outcome of death, ventricular tachycardia storm or appropriate ICD shock occurred in 59.1% of patients in the ablation group and 68.5% in the medical treatment group (p = 0.04). Our study investigates patients with a very compromised ischaemic heart disease: most of them (64.7%) showed a severe LVEF reduction, an extensive coronary artery disease (55.9% of the patients had three-vessel coronary disease) and were old (half of the subjects were >75 years old). A part of the subjects in whom catheter ablation was ineffective (n = 8, 23.5%), in the remaining ones (n = 26, 76.5%) catheter ablation was not feasible because of the evidence of polymorphic VT or VF, advanced heart failure and high operative risk.
The challenges of an aging tetralogy of Fallot population
Published in Expert Review of Cardiovascular Therapy, 2021
Jennifer P. Woo, Doff B. McElhinney, George K. Lui
Catheter ablation is well established as an important adjunct therapy for arrhythmias associated with CHD, especially for atrial tachyarrhythmias and refractory ventricular tachycardia. Catheter ablation for focal atrial arrythmias and intra-atrial reentrant tachycardia are extremely effective [74,78]. There are, unfortunately, much less data on the efficacy of atrial fibrillation ablation in CHD. Data on ventricular tachycardia ablation are mixed and limited to small case series. Intracardiac ventricular tachycardia mapping demonstrated macroreentry and slow conducting isthmuses related to tissue in the RVOT around surgical scars, patches and valves, which are sometimes amenable to catheter ablation [74,84]. When Sandhu et al. prospectively performed cryoablation on adults with TOF and inducible ventricular tachycardia during PVR surgery, 45% still had inducible ventricular tachycardia after ablation [87]. Another more promising small case series demonstrated no recurrent arrhythmia an average of 5 years after catheter ablation combined with antiarrhythmic therapy [88].
Associations between socioeconomic status, atrial fibrillation, and outcomes: a systematic review
Published in Expert Review of Cardiovascular Therapy, 2018
Elin Danielsen Lunde, Peter Brønnum Nielsen, Sam Riahi, Torben Bjerregaard Larsen, Gregory Y.H. Lip, Kirsten Fonager, Mogens Lytken Larsen, Albert Marni Joensen
Catheter ablation has emerged as a highly relevant alternative to pharmacological therapy for AF aimed for rhythm control. We identified two studies examining this and they both showed that people with high income were more likely to undergo catheter ablation for AF [32,43]. This could partly be explained by the fact that only a minority of AF-patients are referred to a cardiac electrophysiologist for assessment (which is mandatory in order to undergo AF ablation) and patients of low SES may be underrepresented. A Canadian study has showed that AF-patients living in rural areas were less likely to receive assessment by a cardiac electrophysiologist. However, they were more likely to receive catheter ablation if they did receive an assessment by a cardiac electrophysiologist [80]. Although residency is not considered as an indicator of SES per se, the aspects are closely related [81]. Furthermore, like NOAC treatment, catheter ablation is probably also directly associated with insurance status. These two studies were based on data from USA and it may be different in countries with more inclusive health care coverage.
Related Knowledge Centers
- Arrhythmia
- Atrial Fibrillation
- Atrial Flutter
- Cardiac Arrest
- Cryoablation
- Premature Ventricular Contraction
- Radiofrequency Ablation
- Ventricular Fibrillation
- Heart
- Wolff–Parkinson–White Syndrome