EHRA EUROPACE How to perform epicardial ventricular tachycardia mapping and ablation

Size: px
Start display at page:

Download "EHRA EUROPACE How to perform epicardial ventricular tachycardia mapping and ablation"

Transcription

1 EHRA EUROPACE 2011 How to perform epicardial ventricular tachycardia mapping and ablation Jacob Atié Director Arrhythmias Department Federal University of Rio de janeiro

2 Presenter Disclosure Information None Jacob Atié Director Arrhythmias Department Federal University of Rio de Janeiro

3 Epicardial Mapping / Ablation Why Epicardial Ablation? How to predict? How to perform? In Whom? When?

4 HCMP Epicardial VT SCAR RF Normal Tissue d Avila,Sosa, Scanavacca. Heart Rhythm 09/2006. Vol 3;9:

5 ARVC/ Dysplasia Cruz F, Atie J, Am J Pathology 1990:3,

6 DCMP - MRI Most pt have an ICD Delayed Enhacement

7 Epicardial Tachycardia How to predict epicardial tachycardia? ECG

8 ECG Recognition of Epicardial VT Endo Epi A B ID=126 ms ID=179 ms Intrinsic deflection = 27 ms = 72 ms RS= 165 ms RS= 213 ms STIM REG TAT Berruezo. Circulation 2004; 109:

9 ECG Criteria to Identify Epicardial VT Algorhythm 14 pt with NICMP 102 epi 67 endo pacemap Vallès, Marchlinski. Circ Arrhythm Electrophysiol. 2010;3:63-71.

10 Epicardial Mapping / Ablation HOW to PERFORM?

11 Epicardial techniques in the EP Lab Sosa et al. JCE 1996

12

13 Tuohy needle Larrey s space André D Avila frame

14 Subxyphoid pericardial space acces Avoid perfuration of the left liver lobus, stomach and colon Courtesy M. Scanavacca

15 RV CS Tuohy needle Xyphoid contrast needle Guide wire Epicardial catheter Epicardial catheter Sosa. JCE- 1996;7: 531 Sosa. JACC- 2000;35: 1442

16 Courtesy Dr Sosa

17

18 Pericardial Access Sacher et al. JACC 2010;55;

19 Needle, Sheeths and Catheters Needle tuohy Sheeths normal steerable Catheters irrigated open or closed Two punctures Sheeth bigger catheter Take out the catheter from time to time

20 Mapping and Ablation VT Chagas Disease Endocardial mapping Epicardial mapping scar scar

21 Correlation Endo e Epi

22 Relationship of fat thickness with low-voltage area Low voltage 6 mm (> 4mm) 3 mm Tung. Epicardial Fat and Scar in Porcine Infarct Model. Heart Rhythm 2010;7:

23 Electroanatomic map and gross pathologic correlation Tung.. Heart Rhythm 2010;7:

24 Coronary anatomy RV LV

25 Acute and Chronic Effects of Epicardial RF Delivered on Epicardial Coronary Arteries In Porcine Media thickness 0.25 mm 0.28 mm Acute chronic Results: 1. no infarction 2. no vascular thrombosis 3. intimal thickening 4. long-term significance? Intimal tickening 0.13 mm x 0.18 mm Acute chronic 20 days 70 days Ville, Sosa, Circ Arrhythm Electrophysiol Jun

26 HRS/EHRA VT Ablation Consensus Document Deliver RF in epicardial ablation at least 5 mm distance from coronary artery Clinical situation will determine where to go

27 In whom do we need to perform epicardial mapping

28 ARVC-VT: Endocardial Ablation WHY? Progressive and difuse disease? Epicardial substrate? Survival Free of Ventricular Tachycardia Recurrence Dalal. J. Am. Coll. Cardiol. 2007;50;

29 ARV Dysplasia / C RV and LV Cruz F, Atie J, Am J Pathology 1990:3,

30 13 pt VT ablation Endocardial No success Endocardial x Epicardial ARVD Garcia, Marchlinski. Circulation 2009; 120:

31 Identification of Slow Conduction on Epi VT PACE Garcia, Marchlinski. Circulation 2009; 120:

32 Outcome with Epicardial Ablation 13 pt FUP: 18, months VT target : endo 4 pt : 9 VT epi 13 pt: 27 VT Inducible after ablation : 2 pt Recurrence VT : 2 +1 pt Garcia, Marchlinski. Circulation 2009; 120:

33 Epicardial and Endocardial Mapping of HCM-related VT Multicentric (4) - 11 pt EP Study SCAR MMVT: 7 Epi: 3 PVT: 1 Epi + Endo: 5 MMVT is uncommon Non inducible: 3 Endo only: 1 and scar related No scar: 2 EPI and ENDO map Should be considered Apex involvement: 7 Dukkipati, Reddy, Soejima,,Bala,,Marchlinski, Inada, Stevenson, Heart Rhythm 2010

34 Chagas VT Ablation with regular 4mm catheter -Recurrence- Scanavacca-Sosa-. Pacing Clin Electrophisiology 2002;25(3):368-71

35 Endocardial and Epicardial Radiofrequency Ablation of Ventricular Tachycardia Associated With Dilated Cardiomyopathy Soejima et al. JACC 2004;43:

36 After Inferior MI more epicardial circuits Tedrow, Stevenson. JCE 2009;20(6):710-3

37 Male 52 years ; Post MI VT Multiple shocks (ICD) Endocardial ablation 2x (1 year); epicardial 2x (6 months) 410ms

38 Epicardial ablation Sub-xyphoid window

39 Male 52 years ; Post MI VT Multiple shocks Endocardial ablation 2x (1 year); epicardial 2x (6 months)

40 Recurrence events Combined Endocardial and Epicardial RF Ablation of VTs N = 376 pts 3-year recurrence 1-year recurrence 1,8,6,4,2 0 Chagas VT Post MI-VT IDCM P = epicardial VTs Other VTs Chagas Post-MI (IDCM) Provided by Sosa in 2008

41 Epicardial Ventricular Tachycardia Ablation Multicenter Study 156/913 (17%) Safety and midterm complications months 45 Acute complications:5% 40 Pericardial effusion 8 Coronary 35stenosis 1 % Freedon from VT 71% Chronic complications:2% Late tamponade 1 Coronary occlusion 1 Inflamatory pericardium 1 Ischemic Idiop CMP ARVD No CMP other CMP 5 0 Ischemic Idiop CMP ARVD No CMP other CMP All Adapted from Sacher et al. JACC 2010;55;

42 Epicardial Mapping A First Line Approach? Protetic Ao and Mitral valve Trombus in the left ventricle Failed endocardial ablation Wire in the epicardial space + Heparine + Endo map Chagas Disease ARVC, DCM + epicardial ECG (MRI) Ischemic Inferior MI + epicardial ECG (MRI) HCM + epicardial ECG?? (MRI)

43 Thank you

Ablation of Ventricular Tachycardia in Non-Ischemic Cardiomyopathy

Ablation of Ventricular Tachycardia in Non-Ischemic Cardiomyopathy Ablation of Ventricular Tachycardia in Non-Ischemic Cardiomyopathy Fermin C Garcia, MD University of Pennsylvania Cardiac Electrophysiology Philadelphia, PA Nothing to disclose No conflict of interest

More information

Epicardial Approach to Mapping and Ablation of VT: Clinical and ECG Predictors of Epicardial Location

Epicardial Approach to Mapping and Ablation of VT: Clinical and ECG Predictors of Epicardial Location Epicardial Approach to Mapping and Ablation of VT: Clinical and ECG Predictors of Epicardial Location Mathew D. Hutchinson, MD, FACC, FHRS Perelman School of Medicine University of Pennsylvania Presenter

More information

Technique of Epicardial VT Ablation

Technique of Epicardial VT Ablation CARTO Club Jan 2014 Technique of Epicardial VT Ablation Amir AbdelWahab, MD Electrophysiology and Pacing Service Department of Cardiovascular Medicine, Cairo University Need for Epicardial VT ablation

More information

Epicardial VT Ablation The Cleveland Clinic Experience

Epicardial VT Ablation The Cleveland Clinic Experience Epicardial VT Ablation The Cleveland Clinic Experience Walid Saliba, MD, FHRS Director, EP Lab Cardiac Electrophysiology Heart and Vascular Institute Epicardial Access in the EP Lab Why Epicardial Special

More information

Indications for catheter ablation in 2010: Ventricular Tachycardia

Indications for catheter ablation in 2010: Ventricular Tachycardia Indications for catheter ablation in 2010: Ventricular Tachycardia Paolo Della Bella, MD Arrhythmia Department and Clinical Electrophysiology Laboratories Ospedale San Raffaele, IRCCS, Milan, Italy Europace

More information

NAAMA s 24 th International Medical Convention Medicine in the Next Decade: Challenges and Opportunities Beirut, Lebanon June 26 July 2, 2010

NAAMA s 24 th International Medical Convention Medicine in the Next Decade: Challenges and Opportunities Beirut, Lebanon June 26 July 2, 2010 NAAMA s 24 th International Medical Convention Medicine in the Next Decade: Challenges and Opportunities Beirut, Lebanon June 26 July 2, 2010 I have a financial interest/arrangement or affiliation with

More information

Catheter ablation of monomorphic ventricular tachycardia. Department of Cardiology, IKEM, Prague, Czech Republic

Catheter ablation of monomorphic ventricular tachycardia. Department of Cardiology, IKEM, Prague, Czech Republic Catheter ablation of monomorphic ventricular tachycardia Department of Cardiology, IKEM, Prague, Czech Republic DECLARATION OF CONFLICT OF INTEREST None Ventricular tachycardia ablation in IKEM, Prague

More information

Disclosures 8/29/2016. VT Ablation 2016: Indications and Expected Outcomes. Medtronic: advisory board, review panel. St Jude Medical: speakers bureau

Disclosures 8/29/2016. VT Ablation 2016: Indications and Expected Outcomes. Medtronic: advisory board, review panel. St Jude Medical: speakers bureau VT Ablation 2016: Indications and Expected Outcomes California Heart Rhythm Symposium 2016 Henry H. Hsia, MD, FACC, FHRS San Francisco VA Medical Center, University of California, San Francisco Disclosures

More information

Epicardial Ventricular Tachycardia Ablation

Epicardial Ventricular Tachycardia Ablation Journal of the American College of Cardiology Vol. 55, No. 21, 2010 2010 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2009.10.084

More information

Map-Guided Ablation of Non-ischemic VT. Takashi Nitta Cardiovascular Surgery, Nippon Medical School Tokyo, JAPAN

Map-Guided Ablation of Non-ischemic VT. Takashi Nitta Cardiovascular Surgery, Nippon Medical School Tokyo, JAPAN Map-Guided Ablation of Non-ischemic VT Takashi Nitta Cardiovascular Surgery, Nippon Medical School Tokyo, JAPAN nothing Declaration of Interest Catheter Ablation of Non-ischemic VT Sarcoidosis, 13, 6%

More information

Ventricular tachycardia ablation

Ventricular tachycardia ablation Ventricular tachycardia ablation Paolo Della Bella, Corrado Carbucicchio, Nicola Trevisi Arrhythmia Department, Institute of Cardiology, University of Milan, Centro Cardiologico Monzino, Milan, Italy Key

More information

- Special VT Cases - Idiopathic Dilated Cardiomyopathy. D. Bänsch

- Special VT Cases - Idiopathic Dilated Cardiomyopathy. D. Bänsch - Special VT Cases - Idiopathic Dilated Cardiomyopathy D. Bänsch Introduction VT Ablation in CAD Strickberger SA, et al. J Am Coll Cardiol 2000 (35: 414-21) Sra J. et al. Pacing Clin Electrophysiol 2001

More information

Πρώτης γραμμή θεραπεία η κατάλυση κοιλιακής ταχυκαρδίας στην ισχαιμική μυοκαρδιοπάθεια

Πρώτης γραμμή θεραπεία η κατάλυση κοιλιακής ταχυκαρδίας στην ισχαιμική μυοκαρδιοπάθεια Πρώτης γραμμή θεραπεία η κατάλυση κοιλιακής ταχυκαρδίας στην ισχαιμική μυοκαρδιοπάθεια Δ. Τσιαχρής Διευθυντής Εργαστηρίου Ηλεκτροφυσιολογίας - Βηματοδότησης, Ιατρικό Κέντρο Αθηνών, Αθήνα Ventricular tachycardia

More information

ΔΠΔΜΒΑΣΙΚΗ ΘΔΡΑΠΔΙΑ ΚΟΙΛΙΑΚΩΝ ΑΡΡΤΘΜΙΩΝ

ΔΠΔΜΒΑΣΙΚΗ ΘΔΡΑΠΔΙΑ ΚΟΙΛΙΑΚΩΝ ΑΡΡΤΘΜΙΩΝ ΔΠΔΜΒΑΣΙΚΗ ΘΔΡΑΠΔΙΑ ΚΟΙΛΙΑΚΩΝ ΑΡΡΤΘΜΙΩΝ ΣΔΛΙΟ ΠΑΡΑΚΔΤΑÏΓΗ ΓΙΔΤΘΤΝΣΗ ΔΤ Α Καρδιολογική Κλινική ΑΠΘ, Νοζοκομείο ΑΧΕΠΑ, Θεζζαλονίκη NO CONFLICT OF INTEREST INTRODUCTION Sustained VT is an important cause

More information

Advances in Ablation Therapy for Ventricular Tachycardia

Advances in Ablation Therapy for Ventricular Tachycardia Advances in Ablation Therapy for Ventricular Tachycardia Nitish Badhwar, MD, FACC, FHRS Director, Cardiac Electrophysiology Training Program University of California, San Francisco For those of you who

More information

ECG Criteria to Identify Epicardial Ventricular Tachycardia in Nonischemic Cardiomyopathy

ECG Criteria to Identify Epicardial Ventricular Tachycardia in Nonischemic Cardiomyopathy ECG Criteria to Identify Epicardial Ventricular Tachycardia in Nonischemic Cardiomyopathy Ermengol Vallès, MD; Victor Bazan, MD; Francis E. Marchlinski, MD Background ECG criteria identifying epicardial

More information

Cardiovascular Surgery

Cardiovascular Surgery Cardiovascular Surgery Subxiphoid Surgical Approach for Epicardial Catheter-Based Mapping and Ablation in Patients With Prior Cardiac Surgery or Difficult Pericardial Access Kyoko Soejima, MD; Gregory

More information

Urgent VT Ablation in a Patient with Presumed ARVC

Urgent VT Ablation in a Patient with Presumed ARVC Urgent VT Ablation in a Patient with Presumed ARVC Mr Alex Cambridge, Chief Cardiac Physiologist, St. Barts Hospital, London, UK The patient, a 52 year-old male, attended the ICD clinic without an appointment

More information

Prophylactic ablation

Prophylactic ablation Ventricular tachycardia in ischaemic heart disease. Update on electrical therapy 29 august 2010 Prophylactic ablation Pasquale Notarstefano Cardiovacular Department S. Donato Hospital, Arezzo (IT) Prophylactic

More information

The first human experience of a contact force sensing catheter for epicardial ablation of ventricular tachycardia

The first human experience of a contact force sensing catheter for epicardial ablation of ventricular tachycardia Neth Heart J (2014) 22:225 230 DOI 10.1007/s12471-014-0554-8 ORIGINAL ARTICLE The first human experience of a contact force sensing catheter for epicardial ablation of ventricular tachycardia L. Dabiri

More information

The implantable cardioverter defibrillator is not enough: Ventricular Tachycardia Catheter Ablation in Patients with Structural Heart Disease

The implantable cardioverter defibrillator is not enough: Ventricular Tachycardia Catheter Ablation in Patients with Structural Heart Disease The implantable cardioverter defibrillator is not enough: Ventricular Tachycardia Catheter Ablation in Patients with Structural Heart Disease Paolo Della Bella, MD Arrhythmia Department and Clinical Electrophysiology

More information

Safety and Efficacy of Epicardial Ablation of Ventricular Tachyarrhythmias: Experience from a Tertiary Referral Center in Taiwan

Safety and Efficacy of Epicardial Ablation of Ventricular Tachyarrhythmias: Experience from a Tertiary Referral Center in Taiwan Original Article Acta Cardiol Sin 2018;34:49 58 doi: 10.6515/ACS.201801_34(1).20170724A EP & Arrhythmia Safety and Efficacy of Epicardial Ablation of Ventricular Tachyarrhythmias: Experience from a Tertiary

More information

DELAYED ENHANCEMENT IMAGING IN CHILDREN

DELAYED ENHANCEMENT IMAGING IN CHILDREN NASCI 38 TH ANNUAL MEENG, SEATLE October 3-5, 21 1. DELAYED ENHANCEMENT IN CHILDREN Shi-Joon Yoo, MD Lars Grosse-Wortmann, MD University of Toronto Canada -1. 1. 1. Magnitude image Magnitude images -1.

More information

Ventricular Tachycardia Substrate. For the ablationist. Stanley Tung, MD FRCPC Arrhythmia Service/St Paul Hospital University of British Columbia

Ventricular Tachycardia Substrate. For the ablationist. Stanley Tung, MD FRCPC Arrhythmia Service/St Paul Hospital University of British Columbia Ventricular Tachycardia Substrate For the ablationist Stanley Tung, MD FRCPC Arrhythmia Service/St Paul Hospital University of British Columbia Two Attitudes of Ventricular Tachycardia Ablation 1 2C:\Documents

More information

Should hybrid ablation be the standard of care instead of transcatheter ablation techniques?

Should hybrid ablation be the standard of care instead of transcatheter ablation techniques? Should hybrid ablation be the standard of care instead of transcatheter ablation techniques? Christian Shults, MD Assistant Professor, Georgetown University School of Medicine Cardiac Surgeon, Medstar

More information

Non-Invasive Ablation of Ventricular Tachycardia

Non-Invasive Ablation of Ventricular Tachycardia Non-Invasive Ablation of Ventricular Tachycardia Dr Shaemala Anpalakhan Newcastle upon Tyne Hospitals NHS Foundation Trust Freeman Road, Newcastle Upon Tyne, NE7 7DN Contact: shaemala@doctors.org.uk Introduction

More information

Radiofrequency Energy: Irrigation and Alternate Catheters. Andreas Pflaumer

Radiofrequency Energy: Irrigation and Alternate Catheters. Andreas Pflaumer Radiofrequency Energy: Irrigation and Alternate Catheters Andreas Pflaumer Irrigated tip RF ablation Irrigated tip How does it work? Potential benefits? Potential risks? How is this relevant to pediatric

More information

Novel Approaches to VT Management Glenn M Polin MD

Novel Approaches to VT Management Glenn M Polin MD Novel Approaches to VT Management Glenn M Polin MD Medical Director, Electrophysiology Laboratory John Ochsner Heart and Vascular Institute New Orleans, LA Disclosures Pfizer Speaker Bureau Bristol Myers

More information

Ablative Therapy for Ventricular Tachycardia

Ablative Therapy for Ventricular Tachycardia Ablative Therapy for Ventricular Tachycardia Nitish Badhwar, MD, FACC, FHRS 2 nd Annual UC Davis Heart and Vascular Center Cardiovascular Nurse / Technologist Symposium May 5, 2012 Disclosures Research

More information

Focus on the role of Catheter Ablation: Simple cases Intermediate level Difficult cases (and patients) Impossible (almost )

Focus on the role of Catheter Ablation: Simple cases Intermediate level Difficult cases (and patients) Impossible (almost ) 22nd SHA Scientific Session 21 24 February 2011, Riyadh, KSA Management of Ventricular Arrhythmias: an Overview Corrado Carbucicchio Ventricular Intensive Care Unit Cardiac Arrhythmias Research Centre

More information

Intramural Reentrant Ventricular Tachycardia in a Patient with Severe Hypertensive Left Ventricular Hypertrophy

Intramural Reentrant Ventricular Tachycardia in a Patient with Severe Hypertensive Left Ventricular Hypertrophy Case Report Print ISSN 1738-5520 On-line ISSN 1738-5555 Korean Circulation Journal Intramural Reentrant Ventricular Tachycardia in a Patient with Severe Hypertensive Left Ventricular Hypertrophy Chin-Yu

More information

Two Years Living with the EHRA/HRS Consensus Document of VT Ablation: Need for an Update?

Two Years Living with the EHRA/HRS Consensus Document of VT Ablation: Need for an Update? Two Years Living with the EHRA/HRS Consensus Document of VT Ablation: Need for an Update? David Wilber MD Loyola University of Chicago Disclosures: Biosense / Webster: Consultant, Investigator; Boston

More information

Catheter Ablation of VT Without Structural Heart Disease 성균관의대 온영근

Catheter Ablation of VT Without Structural Heart Disease 성균관의대 온영근 Catheter Ablation of VT Without Structural Heart Disease 성균관의대 온영근 Idiopathic Monomorphic Ventricular Tachycardia Adenosine-sensitive Verapamil-sensitive Propranolol-sensitive Mech (Triggered activity)

More information

Surgical Ablation of Refractory Ventricular Tachycardia in Patients With Nonischemic Cardiomyopathy

Surgical Ablation of Refractory Ventricular Tachycardia in Patients With Nonischemic Cardiomyopathy Surgical Ablation of Refractory Ventricular Tachycardia in Patients With Nonischemic Cardiomyopathy Elad Anter, MD; Mathew D. Hutchinson, MD; Rajat Deo, MD; Haris M. Haqqani, MBBS; David J. Callans, MD;

More information

Electroanatomic Substrate and Outcome of Catheter Ablative Therapy for Ventricular Tachycardia in Setting of Right Ventricular Cardiomyopathy

Electroanatomic Substrate and Outcome of Catheter Ablative Therapy for Ventricular Tachycardia in Setting of Right Ventricular Cardiomyopathy Electroanatomic Substrate and Outcome of Catheter Ablative Therapy for Ventricular Tachycardia in Setting of Right Ventricular Cardiomyopathy Francis E. Marchlinski, MD; Erica Zado, PA-C; Sanjay Dixit,

More information

Endocardial catheter ablation of postinfarction ventricular

Endocardial catheter ablation of postinfarction ventricular Original Article Epicardial Ablation of Ventricular Tachycardia in Ischemic Heart Disease Andrea Sarkozy, MD; Michifumi Tokuda, MD; Usha B. Tedrow, MD; Juan Sieria, MD; Gregory F. Michaud, MD; Gregory

More information

Ablation of Left Ventricular Epicardial Outflow Tract Tachycardia From the Distal Great Cardiac Vein

Ablation of Left Ventricular Epicardial Outflow Tract Tachycardia From the Distal Great Cardiac Vein Journal of the American College of Cardiology Vol. 48, No. 9, 2006 2006 by the American College of Cardiology Foundation ISSN 0735-1097/06/$32.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2006.06.006

More information

PVCs: Do they cause Cardiomyopathy? Raed Abu Sham a, M.D.

PVCs: Do they cause Cardiomyopathy? Raed Abu Sham a, M.D. PVCs: Do they cause Cardiomyopathy? Raed Abu Sham a, M.D. Cardiologist and Electrophysiologist No conflict of interest related to this presentation Objectives 1. PVCs are benign. What is the Evidence?

More information

Journal of the American College of Cardiology Vol. 61, No. 20, by the American College of Cardiology Foundation ISSN /$36.

Journal of the American College of Cardiology Vol. 61, No. 20, by the American College of Cardiology Foundation ISSN /$36. Journal of the American College of Cardiology Vol. 61, No. 20, 2013 2013 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jacc.2013.02.031

More information

Ventricular Tachycardia in Structurally Normal Hearts (Idiopathic VT) Patient Information

Ventricular Tachycardia in Structurally Normal Hearts (Idiopathic VT) Patient Information Melbourne Heart Rhythm Ventricular Tachycardia in Structurally Normal Hearts (Idiopathic VT) Patient Information What is Ventricular Tachycardia? Ventricular tachycardia (VT) is an abnormal rapid heart

More information

Case Report Epicardial Ablation: Prevention of Phrenic Nerve Damage by Pericardial Injection of Saline and the Use of a Steerable Sheath

Case Report Epicardial Ablation: Prevention of Phrenic Nerve Damage by Pericardial Injection of Saline and the Use of a Steerable Sheath 87 Case Report Epicardial Ablation: Prevention of Phrenic Nerve Damage by Pericardial Injection of Saline and the Use of a Steerable Sheath Kars Neven, MD 1, Juan Fernández-Armenta, MD 2, David Andreu,

More information

Antiarrhythmic Drugs and Ablation in Patients with ICD and Shocks

Antiarrhythmic Drugs and Ablation in Patients with ICD and Shocks Antiarrhythmic Drugs and Ablation in Patients with ICD and Shocks Alireza Ghorbani Sharif, MD Interventional Electrophysiologist Tehran Arrhythmia Clinic January 2016 Recurrent ICD shocks are associated

More information

Ventricular tachycardia and ischemia. Martin Jan Schalij Department of Cardiology Leiden University Medical Center

Ventricular tachycardia and ischemia. Martin Jan Schalij Department of Cardiology Leiden University Medical Center Ventricular tachycardia and ischemia Martin Jan Schalij Department of Cardiology Leiden University Medical Center Disclosure: Research grants from: Boston Scientific Medtronic Biotronik Sudden Cardiac

More information

Case Report Substrate Based Ablation of Ventricular Tachycardia Through An Epicardial Approach

Case Report Substrate Based Ablation of Ventricular Tachycardia Through An Epicardial Approach www.ipej.org 364 Case Report Substrate Based Ablation of Ventricular Tachycardia Through An Epicardial Approach Aman Makhija DM 1, Ajit Thachil DM 1, C Sridevi, DNB 2, B Hygriv Rao, DM 2, S Jaishankar

More information

Mapping and Ablation of VT in The Operating Room

Mapping and Ablation of VT in The Operating Room Mapping and Ablation of VT in The Operating Room Sanjay Dixit, M.D. Associate Professor, University of Pennsylvania School of Medicine Director, Cardiac Electrophysiology Laboratory, Philadelphia V.A.M.C.

More information

Ventricular Tachycardia Ablation. Saverio Iacopino, MD, FACC, FESC

Ventricular Tachycardia Ablation. Saverio Iacopino, MD, FACC, FESC Ventricular Tachycardia Ablation Saverio Iacopino, MD, FACC, FESC ü Ventricular arrhythmias, both symptomatic and asymptomatic, are common, but syncope and SCD are infrequent initial manifestations of

More information

Surgical Ablation of Refractory Ventricular Tachycardia in Patients with. Non-Ischemic Cardiomyopathy

Surgical Ablation of Refractory Ventricular Tachycardia in Patients with. Non-Ischemic Cardiomyopathy Surgical Ablation of Refractory Ventricular Tachycardia in Patients with Non-Ischemic Cardiomyopathy Running title: Anter et al.; Surgical Ablation of Refractory VT Elad Anter, MD, Mathew D. Hutchinson,

More information

Title. CitationJournal of Electrocardiology, 43(5): Issue Date Doc URL. Type. File Information.

Title. CitationJournal of Electrocardiology, 43(5): Issue Date Doc URL. Type. File Information. Title Pleomorphic ventricular tachycardia originating from Author(s)Yokoshiki, Hisashi; Mitsuyama, Hirofumi; Watanabe, M CitationJournal of Electrocardiology, 43(5): 452-458 Issue Date 2010-09 Doc URL

More information

The influence of fat thickness on the human epicardial bipolar electrogram characteristics: measurements on patients undergoing open-heart surgery

The influence of fat thickness on the human epicardial bipolar electrogram characteristics: measurements on patients undergoing open-heart surgery Europace (2009) 11, 949 953 doi:10.1093/europace/eup156 CLINICAL RESEARCH Miscellaneous The influence of fat thickness on the human epicardial bipolar electrogram characteristics: measurements on patients

More information

Mapping and Ablation of Challenging Outflow Tract VTs: Pulmonary Artery, LVOT, Epicardial

Mapping and Ablation of Challenging Outflow Tract VTs: Pulmonary Artery, LVOT, Epicardial Mapping and Ablation of Challenging Outflow Tract VTs: Pulmonary Artery, LVOT, Epicardial Samuel J. Asirvatham, MD Mayo Clinic Rochester California Heart Rhythm Symposium San Francisco, CA September 8,

More information

Diagnostic Electrophysiology and Ablation

Diagnostic Electrophysiology and Ablation Epicardial Ventricular Tachycardia Ablation for Which Patients? Laurent Roten, Frédéric Sacher, Matthew Daly, Patrizio Pascale, Yuki Komatsu, Khaled Ramoul, Daniel Scherr, Arnaud Chaumeil, Ashok Shah,

More information

VT Ablation in Structural Heart Disease Patient Information

VT Ablation in Structural Heart Disease Patient Information Melbourne Heart Rhythm VT Ablation in Structural Heart Disease Patient Information Ventricular Tachycardia in Structural Heart Disease (VT-SHD) Ventricular tachycardia (VT) is an abnormal rapid heart rhythm

More information

Management of patients with ventricular

Management of patients with ventricular Heart 2000;84:553 559 ELECTROPHYSIOLOGY Radiofrequency catheter ablation of ventricular tachycardia William G Stevenson Harvard Medical School, Brigham and Women s Hospital, Boston, Massachusetts, USA

More information

The presence of epicardial circuits may adversely affect

The presence of epicardial circuits may adversely affect Catheter Ablation of Ventricular Epicardial Tissue A Comparison of Standard and Cooled-Tip Radiofrequency Energy André d Avila, MD; Christopher Houghtaling, BS, MS; Paulo Gutierrez, MD; Olivera Vragovic,

More information

Treatment of VT of Purkinje fiber origin: ablation targets and outcome

Treatment of VT of Purkinje fiber origin: ablation targets and outcome Treatment of VT of Purkinje fiber origin: ablation targets and outcome Ch. Piorkowski University Leipzig - Heart Center - Dept. of Electrophysiology Leipzig, Germany Presenter Disclosure Information Gerhard

More information

Use of Catheter Ablation in the Treatment of Ventricular Tachycardia Triggered by Premature Ventricular Contraction

Use of Catheter Ablation in the Treatment of Ventricular Tachycardia Triggered by Premature Ventricular Contraction J Arrhythmia Vol 22 No 3 2006 Case Report Use of Catheter Ablation in the Treatment of Ventricular Tachycardia Triggered by Premature Ventricular Contraction sao Kato MD, Toru wa MD, Yasushi Suzuki MD,

More information

Radiofrequency catheter ablation of ventricular tachycardia guided by intracardiac echocardiography

Radiofrequency catheter ablation of ventricular tachycardia guided by intracardiac echocardiography Eur J Echocardiography (2004) 5, 34e40 Radiofrequency catheter ablation of ventricular tachycardia guided by intracardiac echocardiography M.R.M. Jongbloed, J.J. Bax), A.E. Borger van der Burg, E.E. Van

More information

Ablation of Post-Infarct VTs Unmasking VT Isthmuses Using Pace-Mapping

Ablation of Post-Infarct VTs Unmasking VT Isthmuses Using Pace-Mapping Ablation of Post-Infarct VTs Unmasking VT Isthmuses Using Pace-Mapping Christian de Chillou, MD, PhD Department of Cardiology University Hospital Nancy, France 29/05/2015 Post-infarct mappable VT Isthmus

More information

Editorial Mapping for the Target Sites of Ablation in Post-infarction Ventricular Tachycardia- Is Sinus Rhythm Sufficient?

Editorial Mapping for the Target Sites of Ablation in Post-infarction Ventricular Tachycardia- Is Sinus Rhythm Sufficient? www.ipej.org 286 Editorial Mapping for the Target Sites of Ablation in Post-infarction Ventricular Tachycardia- Is Sinus Rhythm Sufficient? Narayanan Namboodiri, MD, DM Sree Chitra Tirunal Institute for

More information

Case Report Catheter ablation of ventricular tachycardia related to a septo-apical left ventricular aneurysm

Case Report Catheter ablation of ventricular tachycardia related to a septo-apical left ventricular aneurysm Int J Clin Exp Med 2015;8(10):19576-19580 www.ijcem.com /ISSN:1940-5901/IJCEM0014701 Case Report Catheter ablation of ventricular tachycardia related to a septo-apical left ventricular aneurysm Radu Rosu

More information

Creating Transmural, Linear Epicardial Ablation Lesions via a Non-surgical, Percutaneous, Subxyphoid, Electrogram-guided Approach

Creating Transmural, Linear Epicardial Ablation Lesions via a Non-surgical, Percutaneous, Subxyphoid, Electrogram-guided Approach The Journal of Innovations in Cardiac Rhythm Management, 3 (2012), 647 653 ATRIAL FIBRILLATION RESEARCH ARTICLE Creating Transmural, Linear Epicardial Ablation Lesions via a Non-surgical, Percutaneous,

More information

Clinical Results of Scar Related Ventricular Tachycardia Ablation Performed in a South America School Hospital

Clinical Results of Scar Related Ventricular Tachycardia Ablation Performed in a South America School Hospital Clinical Results of Scar Related Ventricular Tachycardia Ablation Performed in a South America School Hospital Cristiano Pisani, Carina Hardy, Sissy Lara, Muhieddine Chokr, Hugo Bellotti, Tan Chen Wu,

More information

Cardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition

Cardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition Cardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition Table of Contents Volume 1 Chapter 1: Cardiovascular Anatomy and Physiology Basic Cardiac

More information

Effect of Epicardial Fat on Electroanatomical Mapping and Epicardial Catheter Ablation

Effect of Epicardial Fat on Electroanatomical Mapping and Epicardial Catheter Ablation Journal of the American College of Cardiology Vol. 56, No. 16, 2010 2010 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2010.04.054

More information

What s New/Improved/Exciting in EP

What s New/Improved/Exciting in EP What s New/Improved/Exciting in EP NANCY C. BERG, MA, RN, ANP-BC,AACC Agenda 1. Review Atrial fibrillation 2. Pulmonary vein Isolation ablation (PVI 3. Atrial Fibrillation and the Left Atrial appendage

More information

Cover Page. The handle holds various files of this Leiden University dissertation

Cover Page. The handle  holds various files of this Leiden University dissertation Cover Page The handle http://hdl.handle.net/1887/37413 holds various files of this Leiden University dissertation Author: Piers, S.R.D. Title: Understanding ventricular tachycardia : towards individualized

More information

Sudden Cardiac Death What an electrophysiologist thinks a cardiologist should know

Sudden Cardiac Death What an electrophysiologist thinks a cardiologist should know Sudden Cardiac Death What an electrophysiologist thinks a cardiologist should know Steven J. Kalbfleisch, M.D. Medical Director Electrophysiology Laboratory Ross Heart Hospital Wexner Medical Center Sudden

More information

Isolated Potentials and Pace-Mapping as Guides for Ablation of Ventricular Tachycardia in Various Types of Nonischemic Cardiomyopathy

Isolated Potentials and Pace-Mapping as Guides for Ablation of Ventricular Tachycardia in Various Types of Nonischemic Cardiomyopathy Isolated Potentials and Pace-Mapping as Guides for Ablation of Ventricular Tachycardia in Various Types of Nonischemic Cardiomyopathy MICHAEL KÜHNE, M.D., GERALD ABRAMS, M.D., JEAN-FRANCOIS SARRAZIN, M.D.,

More information

Interventional solutions for atrial fibrillation in patients with heart failure

Interventional solutions for atrial fibrillation in patients with heart failure Interventional solutions for atrial fibrillation in patients with heart failure Advances in Cardiovascular Arrhythmias Great Innovations in Cardiology Matteo Anselmino, MD PhD Division of Cardiology Department

More information

Risk Factors for Sudden cardiac Death

Risk Factors for Sudden cardiac Death Risk Factors for Sudden cardiac Death A. Arenal Arrhythmias in competitive sports Disclosure Conflict of interest Advisory board: Medtronic, Boston Scientific Research grants: Medtronic, Boston Scientific,

More information

The patient with electric storm

The patient with electric storm The complex patient in the cardiac care unit: The patient with electric storm Helmut U. Klein University of Rochester Medical Center Heart Research Follow-up Program and Isar Heart Center Muenchen Presenter

More information

The value of bipolar (BIP) electroanatomic mapping in

The value of bipolar (BIP) electroanatomic mapping in Endocardial Unipolar Voltage Mapping to Detect Epicardial Ventricular Tachycardia Substrate in Patients With Nonischemic Left Ventricular Cardiomyopathy Mathew D. Hutchinson, MD; Edward P. Gerstenfeld,

More information

Rebuttal. Jerónimo Farré MD 2010

Rebuttal. Jerónimo Farré MD 2010 Rebuttal 1.We do not know what are the types of AF in which ablation is worthless or most effective 2.Waiting implies to consider the ablation at an older age and when the duration of the history of AF

More information

Since its publication in 1996 by Sosa and colleagues, 1 the

Since its publication in 1996 by Sosa and colleagues, 1 the Epicardial Ablation for Ventricular Tachycardia A European Multicenter Study Paolo Della Bella, MD, FESC; Josep Brugada, MD; Katja Zeppenfeld, MD; Jose Merino, MD; Petr Neuzil, MD; Philippe Maury, MD;

More information

Sustained monomorphic ventricular tachycardia (VT) due to

Sustained monomorphic ventricular tachycardia (VT) due to Identification of the Ventricular Tachycardia Isthmus After Infarction by Pace Mapping Corinna B. Brunckhorst, MD; Etienne Delacretaz, MD; Kyoko Soejima, MD; William H. Maisel, MD, MPH; Peter L. Friedman,

More information

Reentrant Ventricular Tachycardia Originating in the Right Ventricular Outflow Tract

Reentrant Ventricular Tachycardia Originating in the Right Ventricular Outflow Tract Circ J 2008; 72: 855 860 Reentrant Ventricular Tachycardia Originating in the Right Ventricular Outflow Tract Slow Conduction Identified by Right Coronary Artery Ostium Pacing Emi Nakano, MD; Tomoo Harada,

More information

Endocardial radiofrequency (RF) ablation is the common

Endocardial radiofrequency (RF) ablation is the common Electrocardiographic Recognition of the Epicardial Origin of Ventricular Tachycardias Antonio Berruezo, MD; Lluis Mont, MD; Santiago Nava, MD; Enrique Chueca, MD; Eduardo Bartholomay, MD; Josep Brugada,

More information

Declaration of conflict of interest NONE

Declaration of conflict of interest NONE Declaration of conflict of interest NONE Transatlantic Electrophysiology Lessons for and from Iberoamerica European Society of Cardiology Mexican Society of Cardiology Wolff-Parkinson-White Syndrome in

More information

Electrical Storm in Coronary Artery Disease. Saeed Oraii MD, Cardiologist Interventional Electrophysiologist Tehran Arrhythmia Clinic July 2016

Electrical Storm in Coronary Artery Disease. Saeed Oraii MD, Cardiologist Interventional Electrophysiologist Tehran Arrhythmia Clinic July 2016 Electrical Storm in Coronary Artery Disease Saeed Oraii MD, Cardiologist Interventional Electrophysiologist Tehran Arrhythmia Clinic July 2016 48 yrs. Old diabetic with ACS 48 yrs. Old diabetic with ACS

More information

Cover Page. The handle holds various files of this Leiden University dissertation.

Cover Page. The handle   holds various files of this Leiden University dissertation. Cover Page The handle http://hdl.handle.net/1887/18608 holds various files of this Leiden University dissertation. Author: Wijnmaalen, Adrianus Pieter Title: Substrate of ventricular tachycardia Issue

More information

What s new in my specialty?

What s new in my specialty? What s new in my specialty? Jon Melman, MD Heart Rhythm Specialists McKay-Dee Hospital some would say some would say my specialty 1 some would say my specialty First pacemaker 1958 some would say my specialty

More information

EAE Teaching Course. Magnetic Resonance Imaging. Competitive or Complementary? Sofia, Bulgaria, 5-7 April F.E. Rademakers

EAE Teaching Course. Magnetic Resonance Imaging. Competitive or Complementary? Sofia, Bulgaria, 5-7 April F.E. Rademakers EAE Teaching Course Magnetic Resonance Imaging Competitive or Complementary? Sofia, Bulgaria, 5-7 April 2012 F.E. Rademakers Complementary? Of Course N Engl J Med 2012;366:54-63 Clinical relevance Treatment

More information

Case Report Mapping and Surgical Ablation of Focal Epicardial Left Ventricular Tachycardia

Case Report Mapping and Surgical Ablation of Focal Epicardial Left Ventricular Tachycardia Hindawi Publishing Corporation Case Reports in Cardiology Volume 11, Article ID 4139, 5 pages doi:.1155/11/4139 Case Report Mapping and Surgical Ablation of Focal Epicardial Left Ventricular Tachycardia

More information

SUDDEN CARDIAC DEATH(SCD): Definition

SUDDEN CARDIAC DEATH(SCD): Definition SUDDEN CARDIAC DEATH EPIDEMIOLOGY, PATHOPHYSIOLOGY, PREVENTION & THERAPY Hasan Garan, M.D. Columbia University Medical Center SUDDEN CARDIAC DEATH(SCD): Definition DEATH DUE TO A CARDIAC CAUSE IN A CLINICALLY

More information

Catheter Ablation for Atrial Fibrillation: Patient Selection and Outcomes

Catheter Ablation for Atrial Fibrillation: Patient Selection and Outcomes Catheter Ablation for Atrial Fibrillation: Patient Selection and Outcomes Francis Marchlinski, MD Richard T and Angela Clark President s Distinguished Professor Director Cardiac Electrophysiolgy University

More information

When to implant an ICD in systemic right ventricle?

When to implant an ICD in systemic right ventricle? When to implant an ICD in systemic right ventricle? Département de rythmologie et de stimulation cardiaque Nicolas Combes n.combes@clinique-pasteur.com Pôle de cardiologie pédiatrique et congénitale Risk

More information

Long-Term Outcome and Risks of Catheter Ablation for Atrial Fibrillation

Long-Term Outcome and Risks of Catheter Ablation for Atrial Fibrillation Long-Term Outcome and Risks of Catheter Ablation for Atrial Fibrillation Carlo Pappone, MD, PhD, FACC EP Director, Villa Maria Hospital Group How many times AF can increase mortality DO MORTALITY REALLY

More information

SUDDEN CARDIAC DEATH(SCD): Definition

SUDDEN CARDIAC DEATH(SCD): Definition SUDDEN CARDIAC DEATH EPIDEMIOLOGY, PATHOPHYSIOLOGY, PREVENTION & THERAPY Hasan Garan, M.D. Columbia University Medical Center SUDDEN CARDIAC DEATH(SCD): Definition DEATH DUE TO A CARDIAC CAUSE IN A CLINICALLY

More information

Einleitung. Kammertachykardien. Ventrikuläre Tachykardien S.H.E. Idiopathic Katheterablation bei Kammertachykardien

Einleitung. Kammertachykardien. Ventrikuläre Tachykardien S.H.E. Idiopathic Katheterablation bei Kammertachykardien Katheterablation bei Kammertachykardien Ist die Katheterablation als Primärtherapie überzeugend? Einleitung Kammertachykardien Arash Arya Herzzentrum Universität Leipzig VT VES >420 2016 Ventrikuläre Tachykardien

More information

1-3 JUNE, 2018 PROGRAMME CLINICAL ELECTROPHYSIOLOGY AND CATHETER ABLATION OF TACHYCARDIA FOR INTERVENTIONAL CARDIOLOGISTS MOSCOW, RUSSIA.

1-3 JUNE, 2018 PROGRAMME CLINICAL ELECTROPHYSIOLOGY AND CATHETER ABLATION OF TACHYCARDIA FOR INTERVENTIONAL CARDIOLOGISTS MOSCOW, RUSSIA. European Heart Rhythm Association Russian Scientific Society of Clinical Electrophysiology, Arrhythmology and Cardiac Pacing PROGRAMME CLINICAL ELECTROPHYSIOLOGY AND CATHETER ABLATION OF TACHYCARDIA FOR

More information

Title. CitationJournal of electrocardiology, 46(6): Issue Date Doc URL. Type. File Information

Title. CitationJournal of electrocardiology, 46(6): Issue Date Doc URL. Type. File Information Title Unique preferential conduction within the isolated s with non-ischemic dilated cardiomyopathy Author(s)Watanabe, Masaya; Yokoshiki, Hisashi; Mitsuyama, Hir CitationJournal of electrocardiology, 46(6):

More information

ARVC when TO IMPLANT THE ASYMPTOMATIC PERSON

ARVC when TO IMPLANT THE ASYMPTOMATIC PERSON EUROPACE 2011 INHERITED ELECTRICAL CARDIAC DISORDERS ARVC when TO IMPLANT THE ASYMPTOMATIC PERSON June 26 th 2011 Robert Lemery MD CONFLICTS of INTEREST None ASYMPTOMATIC ARVC 1. ECG 2. ASYMPTOMATIC PVC

More information

When to ablate patients with premature ventricular complexes?

When to ablate patients with premature ventricular complexes? When to ablate patients with premature ventricular complexes? Nikolaos Fragakis Assistant Professor, FESC 3rd University Cardiology Department Hippokration Hospital, Thessaloniki 58 year-old female Case

More information

Anatomic Relationships Between the Coronary Venous System, Surrounding Structures, and the Site of Origin of Epicardial Ventricular Arrhythmias

Anatomic Relationships Between the Coronary Venous System, Surrounding Structures, and the Site of Origin of Epicardial Ventricular Arrhythmias 1336 Anatomic Relationships Between the Coronary Venous System, Surrounding Structures, and the Site of Origin of Epicardial Ventricular Arrhythmias THOMAS P. CARRIGAN, M.D., F.H.R.S., SMITA PATEL, M.D.,

More information

Ventricular Arrhythmias

Ventricular Arrhythmias Presenting your most challenging cases Venice Arrhythmias Ventricular Arrhythmias Gioia Turitto, MD Presenter Disclosure Information A questionable indication for CRT-D in a patient with VT after successful

More information

Girish M Nair. MBBS, Jeffrey S Healey. MD, Elaine Gordon. MD, Syamkumar Divakaramenon MBBS, Carlos A Morillo. MD.

Girish M Nair. MBBS, Jeffrey S Healey. MD, Elaine Gordon. MD, Syamkumar Divakaramenon MBBS, Carlos A Morillo. MD. www.ipej.org 120 Case Report Catheter Ablation of Hemodynamically Unstable Ventricular Tachycardia in a Patient with Dextro - Transposition of the Great Arteries and Mustard's Repair Girish M Nair. MBBS,

More information

Mini-Electrodes Help Identify Hidden Slow Conduction. during Ventricular Tachycardia Substrate Ablation

Mini-Electrodes Help Identify Hidden Slow Conduction. during Ventricular Tachycardia Substrate Ablation Mini-Electrodes Help Identify Hidden Slow Conduction during Ventricular Tachycardia Substrate Ablation A CASE REPORT Short title: Usefulness of mini-electrode catheter during VT substrate ablation David

More information

AF ABLATION Concepts and Techniques

AF ABLATION Concepts and Techniques AF ABLATION Concepts and Techniques Antony F Chu, M.D. Director of Complex Ablation Arrhythmia Services Section Division of Cardiology at the Rhode Island and Miriam Hospital HIGHLIGHTS The main indications

More information

SPORTS AND EXERCISE ADVICE IN PATIENTS WITH ICD AND PPM

SPORTS AND EXERCISE ADVICE IN PATIENTS WITH ICD AND PPM SPORTS AND EXERCISE ADVICE IN PATIENTS WITH ICD AND PPM Rio De Janeiro 2016 Sport and Exercise Cardiology Symposium SBC/SOCERJ ACC Sharlene M. Day, MD Associate Professor, Cardiovascular Medicine Director,

More information