Substrate characterization and catheter ablation for monomorphic ventricular tachycardia in patients with apical hypertrophic cardiomyopathy
Standard
Substrate characterization and catheter ablation for monomorphic ventricular tachycardia in patients with apical hypertrophic cardiomyopathy. / Inada, Keiichi; Seiler, Jens; Roberts-Thomson, Kurt C; Steven, Daniel; Rosman, Jonathan; John, Roy M; Sobieszczyk, Piotr; Stevenson, William G; Tedrow, Usha B.
In: J CARDIOVASC ELECTR, Vol. 22, No. 1, 01.2011, p. 41-48.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Substrate characterization and catheter ablation for monomorphic ventricular tachycardia in patients with apical hypertrophic cardiomyopathy
AU - Inada, Keiichi
AU - Seiler, Jens
AU - Roberts-Thomson, Kurt C
AU - Steven, Daniel
AU - Rosman, Jonathan
AU - John, Roy M
AU - Sobieszczyk, Piotr
AU - Stevenson, William G
AU - Tedrow, Usha B
N1 - © 2010 Wiley Periodicals, Inc.
PY - 2011/1
Y1 - 2011/1
N2 - UNLABELLED: VT Ablation in Apical Hypertrophic Cardiomyopathy. INTRODUCTION: Monomorphic ventricular tachycardia (VT) is uncommon in apical hypertrophic cardiomyopathy (HCM). The purpose of this study was to define the substrate and role of catheter ablation for VT in apical HCM.METHODS: Four patients with apical HCM and frequent, drug refractory VT (mean age of 46 ± 10 years, left ventricular [LV] ejection fraction; 54 ± 14%) underwent catheter ablation with the use of electroanatomic mapping. Endocardial mapping was performed in 4 patients and 3 patients underwent epicardial mapping.RESULTS: In 3 patients, VT was related to areas of scar in the apical LV where maximal apical wall thickness ranged from 14.5 to 17.8 mm, and 2 patients had apical aneurysms. Endocardial and epicardial substrate mapping revealed low voltage (<1.5 mV) scar in both endocardial and epicardial LV in 2 and only in the epicardium in 1 patient. Inducible VT was abolished with a combination of endocardial and epicardial ablation in 2 patients, but was ineffective in the third patient who had intramural reentry that required transcoronary ethanol ablation of an obtuse marginal vessel for abolition. The fourth patient had focal nonsustained repetitive VT from right ventricular outflow tract (RVOT), consistent with idiopathic RVOT-VT, that was successfully ablated. During follow-ups of 3-9 months, all patients remained free from VT.CONCLUSION: Monomorphic VT in apical HCM can be due to endocardial, epicardial or intramural reentry in areas of apical scar. Epicardial ablation or transcoronary alcohol ablation is required in some cases.
AB - UNLABELLED: VT Ablation in Apical Hypertrophic Cardiomyopathy. INTRODUCTION: Monomorphic ventricular tachycardia (VT) is uncommon in apical hypertrophic cardiomyopathy (HCM). The purpose of this study was to define the substrate and role of catheter ablation for VT in apical HCM.METHODS: Four patients with apical HCM and frequent, drug refractory VT (mean age of 46 ± 10 years, left ventricular [LV] ejection fraction; 54 ± 14%) underwent catheter ablation with the use of electroanatomic mapping. Endocardial mapping was performed in 4 patients and 3 patients underwent epicardial mapping.RESULTS: In 3 patients, VT was related to areas of scar in the apical LV where maximal apical wall thickness ranged from 14.5 to 17.8 mm, and 2 patients had apical aneurysms. Endocardial and epicardial substrate mapping revealed low voltage (<1.5 mV) scar in both endocardial and epicardial LV in 2 and only in the epicardium in 1 patient. Inducible VT was abolished with a combination of endocardial and epicardial ablation in 2 patients, but was ineffective in the third patient who had intramural reentry that required transcoronary ethanol ablation of an obtuse marginal vessel for abolition. The fourth patient had focal nonsustained repetitive VT from right ventricular outflow tract (RVOT), consistent with idiopathic RVOT-VT, that was successfully ablated. During follow-ups of 3-9 months, all patients remained free from VT.CONCLUSION: Monomorphic VT in apical HCM can be due to endocardial, epicardial or intramural reentry in areas of apical scar. Epicardial ablation or transcoronary alcohol ablation is required in some cases.
KW - Adult
KW - Body Surface Potential Mapping
KW - Cardiomyopathy, Hypertrophic/diagnosis
KW - Catheter Ablation/methods
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Tachycardia, Ventricular/diagnosis
KW - Treatment Outcome
U2 - 10.1111/j.1540-8167.2010.01875.x
DO - 10.1111/j.1540-8167.2010.01875.x
M3 - SCORING: Journal article
C2 - 20807280
VL - 22
SP - 41
EP - 48
JO - J CARDIOVASC ELECTR
JF - J CARDIOVASC ELECTR
SN - 1045-3873
IS - 1
ER -