Epicardial and Endocardial Ablation Based on Channel Mapping in Patients With Ventricular Tachycardia and Chronic Chagasic Cardiomyopathy: Importance of Late Potential Mapping During Sinus Rhythm to Recognize the Critical Substrate
Background Ventricular tachycardia (VT) in patients with chronic chagasic cardiomyopathy (CCC) is associated with considerable morbidity and mortality. Catheter ablation of VT in patients with CCC is very complex and challenging. The main goal of this work was to assess the efficacy of VT catheter a...
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| Format: | Article |
| Language: | English |
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Wiley
2022-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.021889 |
| _version_ | 1819349645442154496 |
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| author | Cristiano de Oliveira Dietrich Lucas de Oliveira Hollanda Claudio Cirenza Angelo Amato Vincenzo de Paola |
| author_facet | Cristiano de Oliveira Dietrich Lucas de Oliveira Hollanda Claudio Cirenza Angelo Amato Vincenzo de Paola |
| author_sort | Cristiano de Oliveira Dietrich |
| collection | DOAJ |
| description | Background Ventricular tachycardia (VT) in patients with chronic chagasic cardiomyopathy (CCC) is associated with considerable morbidity and mortality. Catheter ablation of VT in patients with CCC is very complex and challenging. The main goal of this work was to assess the efficacy of VT catheter ablation guided by late potentials (LPs) in patients with CCC. Methods and Results Seventeen consecutive patients with refractory VT and CCC were prospectively included in the study. Combined endo‐epicardial voltage and late activation mapping were obtained during baseline rhythm to define scarred and LP areas, respectively. The end point of the ablation procedure was the elimination of all identified LPs. Epicardial and endocardial dense scars (<0.5 mV) were detected in 17/17 and 15/17 patients, respectively. LPs were detected in the epicardial scars of 16/17 patients and in the endocardial scars of 14/15 patients. A total of 63 VTs were induced in 17 patients; 22/63 (33%) were stable and entrained, presenting LPs recorded in the isthmus sites. The end point of ablation was achieved in 15 of 17 patients. Ablation was not completed in 2 patients because of cardiac tamponade or vicinity of the phrenic nerve and circumflex artery. Three patients (2 with unsuccessful ablation) had VT recurrence during follow‐up (39 months). Conclusions Endo‐epicardial LP mapping allows us to identify the putative isthmuses of different VTs and effectively perform catheter ablation in patients with CCC and drug‐refractory VTs. |
| first_indexed | 2024-12-24T19:03:49Z |
| format | Article |
| id | doaj.art-f693bbcf8ea9429eac2c6a5d14350273 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-24T19:03:49Z |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-f693bbcf8ea9429eac2c6a5d143502732022-12-21T16:43:09ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-01-0111110.1161/JAHA.121.021889Epicardial and Endocardial Ablation Based on Channel Mapping in Patients With Ventricular Tachycardia and Chronic Chagasic Cardiomyopathy: Importance of Late Potential Mapping During Sinus Rhythm to Recognize the Critical SubstrateCristiano de Oliveira Dietrich0Lucas de Oliveira Hollanda1Claudio Cirenza2Angelo Amato Vincenzo de Paola3Clinical Cardiac Electrophysiology Cardiology Division Department of Medicine Hospital São Paulo Escola Paulista de Medicina – Universidade Federal of São Paulo São Paulo BrazilClinical Cardiac Electrophysiology Cardiology Division Department of Medicine Hospital São Paulo Escola Paulista de Medicina – Universidade Federal of São Paulo São Paulo BrazilClinical Cardiac Electrophysiology Cardiology Division Department of Medicine Hospital São Paulo Escola Paulista de Medicina – Universidade Federal of São Paulo São Paulo BrazilClinical Cardiac Electrophysiology Cardiology Division Department of Medicine Hospital São Paulo Escola Paulista de Medicina – Universidade Federal of São Paulo São Paulo BrazilBackground Ventricular tachycardia (VT) in patients with chronic chagasic cardiomyopathy (CCC) is associated with considerable morbidity and mortality. Catheter ablation of VT in patients with CCC is very complex and challenging. The main goal of this work was to assess the efficacy of VT catheter ablation guided by late potentials (LPs) in patients with CCC. Methods and Results Seventeen consecutive patients with refractory VT and CCC were prospectively included in the study. Combined endo‐epicardial voltage and late activation mapping were obtained during baseline rhythm to define scarred and LP areas, respectively. The end point of the ablation procedure was the elimination of all identified LPs. Epicardial and endocardial dense scars (<0.5 mV) were detected in 17/17 and 15/17 patients, respectively. LPs were detected in the epicardial scars of 16/17 patients and in the endocardial scars of 14/15 patients. A total of 63 VTs were induced in 17 patients; 22/63 (33%) were stable and entrained, presenting LPs recorded in the isthmus sites. The end point of ablation was achieved in 15 of 17 patients. Ablation was not completed in 2 patients because of cardiac tamponade or vicinity of the phrenic nerve and circumflex artery. Three patients (2 with unsuccessful ablation) had VT recurrence during follow‐up (39 months). Conclusions Endo‐epicardial LP mapping allows us to identify the putative isthmuses of different VTs and effectively perform catheter ablation in patients with CCC and drug‐refractory VTs.https://www.ahajournals.org/doi/10.1161/JAHA.121.021889catheter ablationChagas cardiomyopathyventricular tachycardia |
| spellingShingle | Cristiano de Oliveira Dietrich Lucas de Oliveira Hollanda Claudio Cirenza Angelo Amato Vincenzo de Paola Epicardial and Endocardial Ablation Based on Channel Mapping in Patients With Ventricular Tachycardia and Chronic Chagasic Cardiomyopathy: Importance of Late Potential Mapping During Sinus Rhythm to Recognize the Critical Substrate Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease catheter ablation Chagas cardiomyopathy ventricular tachycardia |
| title | Epicardial and Endocardial Ablation Based on Channel Mapping in Patients With Ventricular Tachycardia and Chronic Chagasic Cardiomyopathy: Importance of Late Potential Mapping During Sinus Rhythm to Recognize the Critical Substrate |
| title_full | Epicardial and Endocardial Ablation Based on Channel Mapping in Patients With Ventricular Tachycardia and Chronic Chagasic Cardiomyopathy: Importance of Late Potential Mapping During Sinus Rhythm to Recognize the Critical Substrate |
| title_fullStr | Epicardial and Endocardial Ablation Based on Channel Mapping in Patients With Ventricular Tachycardia and Chronic Chagasic Cardiomyopathy: Importance of Late Potential Mapping During Sinus Rhythm to Recognize the Critical Substrate |
| title_full_unstemmed | Epicardial and Endocardial Ablation Based on Channel Mapping in Patients With Ventricular Tachycardia and Chronic Chagasic Cardiomyopathy: Importance of Late Potential Mapping During Sinus Rhythm to Recognize the Critical Substrate |
| title_short | Epicardial and Endocardial Ablation Based on Channel Mapping in Patients With Ventricular Tachycardia and Chronic Chagasic Cardiomyopathy: Importance of Late Potential Mapping During Sinus Rhythm to Recognize the Critical Substrate |
| title_sort | epicardial and endocardial ablation based on channel mapping in patients with ventricular tachycardia and chronic chagasic cardiomyopathy importance of late potential mapping during sinus rhythm to recognize the critical substrate |
| topic | catheter ablation Chagas cardiomyopathy ventricular tachycardia |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.021889 |
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