Experience Of Catheter Ablation Research Articles

Catheter ablation of atrial arrhythmias by using a multipolar grid-patterned high density mapping catheter in patients with congenital heart disease: a single-center experience

Abstract Objective Catheter ablation of arrhythmias in patients with congenital heart disease (CHD) remains challenging and time-consuming. A novel diagnostic catheter with a multipolar grid-patterned electrode configuration for high density mapping may reduce mapping time and enhance ablation success. Here we describe our experience of catheter ablation by using a multipolar grid-patterned mapping catheter in patients with CHD suffered from atrial tachycardia. Methods All patients with CHD underwent catheter ablation for atrial tachycardia by using multipolar grid-patterned high density mapping catheter between 04/2018 and 12/2021 were enrolled. Primary success was defined as non-inducibility of atrial tachycardia. Only the first catheter ablation was included in the study. Results A total of 37 consecutive patients (median age 34.2±33.0 years (range 7–65), female n=20) underwent 37 ablation procedures with initial high density mapping. The underlying heart defects were s/p ASD-closure (n=2), ASD-closure and corrected partial anomalous pulmonary venous return (n=2), corrected unroofed coronary sinus (n=1), pulmonary valve commissurotomy (n=2), repaired Tetralogy of Fallot (n=2), tricuspid and pulmonary valve replacement in PA/IVS (n=1), mitral valve replacement (n=1), Hypoplastic right heart syndrome (n=1), atrial switch procedure for dTGA (n=7), TA with Glenn shunt (n=1), Ross operation (n=1), Fontan palliation (tricuspid atresia n=6, DILV n=5, HLHS n=1, DORV n=1, dTGA n=1, criss-cross heart n=1, single ventricle n=1). A history of previous ablation was positive in 8 patients. During mapping of the cardiac chambers, the mean value of total collected points and used points were 32657.8±46171 and 3851.6±3295.5 respectively. Mean mapping and fluoroscopy time were 62.1±40.7 minute (range 3–178) and 11.4±8.5 minutes (range 0–32.2), respectively. There were 69 atrial tachycardia substrates in the 37 patients (median 2, range 1–4 per patient). All tachycardia substrates were completely ablated in 33/37 (89.2%) patients and partially in 4/37 (11.8%) patients. Acute success was achieved with successful ablation of 65 of 69 (94.2%) atrial substrates. During a median follow-up time of 20 months (range 5–49), recurrence rate was 5/65 (7.7%) atrial substrates in 5/37 (13.5%) patients. Comparison of 16 patients with Fontan palliation to the 23 patients without Fontan operation showed higher partially success rate in the patients with Fontan palliation (4/16 vs. 0/21, p=0.028). Conclusion In this series, high density mapping allowed elucidation of the tachycardia mechanism in all patients with a high primary ablation success, a limited radiation exposure and a low rate of arrhythmia recurrence. Funding Acknowledgement Type of funding sources: None.

Radiofrequency Ablation in Brugada Syndrome

In 1992, Brugada brothers first described the clinical-electrocardiographic syndrome which was characterized by changes in the electrocardiogram (ECG), family history of syncopal states and sudden cardiac death (SCD) in the absence of structural heart disease. The standard therapy recommended by the European Society of Cardiology for the prevention of SCD in type I Brugada syndrome (BS) is implantation of a cardioverter-defibrillator. Radiofrequency ablation (RFA) of BS has been performed since the 2000s as an alternative therapy for BS with recurrent ventricular arrhythmias. To date, more than 300 such interventions have been performed by various centers around the world, and multicenter randomized trials are underway to study the long-term results of catheter destruction. We reviewed our experience of catheter ablation in a patient with BS. The patient suffered from ventricular arrhythmias and short-term loss of consciousness. ECG and 24-hour monitoring data recorded ventricular arrhythmias of more than 34% per day and type II BS. Electroanatomical mapping and RFA of the areas with low amplitude graphics were performed by endocardial access. This zone coincided with the earliest activation of the myocardium during ventricular arrhythmias. Extrasystoles were eliminated. In the remote period (10-12 weeks) the patient had no ventricular arrhythmias and there are also no ECG signs of BS.
 Most major arrhythmological centers perform RFA with epicardial access. Our patient chose the endocardial approach as safer. In her specific case, localization of arimogenic substrate allowed to limit this access, and RFA was successful.

Catheter Ablation for Persistent Atrial Fibrillation in Class IV Systolic Heart Failure: A Single-Center Case Series.

Questions remain as to how aggressively catheter ablation for atrial fibrillation may be applied to patients with advanced systolic congestive heart failure, owing to a historic under-representation in multicenter clinical ablation trials. We sought to describe the experience of catheter ablation for persistent atrial fibrillation in Class IV systolic heart failure patients at our institution. All Class IV systolic heart failure patients (left ventricular assist device patients excluded) between 2017 and 2020 referred for radiofrequency ablation were included. Out of 10 patients, 7 agreed to proceed, had restoration of normal sinus rhythm upon completion of the catheter ablation procedure, and of which five (71%) remain in normal rhythm at a mean follow-up of 23 months. Catheter ablation for atrial fibrillation in patients with Class IV chronic systolic heart failure, even on advanced heart failure therapies, is feasible, and can improve heart failure status with maintenance of NSR.

Registry for Real-world Experience of Catheter Ablation for Symptomatic Paroxysmal Atrial Fibrillation

Registry for Real-world Experience of Catheter Ablation for Symptomatic Paroxysmal Atrial Fibrillation

218A single centre experience of catheter ablation in adults with congenital heart disease

218A single centre experience of catheter ablation in adults with congenital heart disease

Three-year experience of catheter ablation of cardiac rhythm disorder in the Chuvash Republic

Three-year experience of catheter ablation of cardiac rhythm disorder in the Chuvash Republic

Catheter Ablation of Pediatric Focal Atrial Tachycardia: Ten-Year Experience Using Modern Mapping Systems.

Experience of catheter ablation of pediatric focal atrial tachycardia (FAT) is still limited. There are data which were gathered prior to the introduction of modern 3D mapping and navigation systems into the clinical routine. Accordingly, procedures were associated with significant fluoroscopy and low success rates. The aim of this study was to present clinical and electrophysiological details of catheter ablation of pediatric FAT using modern mapping systems. Since March 2003, 17 consecutive patients <20 years underwent electrophysiological study (EPS) for FAT using the NavX(®) system (n = 7), the non-contact mapping system (n = 6) or the LocaLisa(®) system (n = 4), respectively. Radiofrequency was the primary energy source; cryoablation was performed in selected patients with a focus close to the AV node. In 16 patients, a total number of 19 atrial foci (right-sided n = 13, left-sided n = 6) could be targeted. In the remaining patient, FAT was not present/inducible during EPS. On an intention-to-treat basis, acute success was achieved in 14/16 patients (87.5 %) with a median number of 11 (1-31) energy applications. Ablation was unsuccessful in two patients due to an epicardial location of a right atrial focus (n = 1) and a focus close to the His bundle (n = 1), respectively. Median procedure time was 210 (84-332) min, and median fluoroscopy time was 13.1 (4.5-22.5) min. In pediatric patients with FAT, 3D mapping and catheter ablation provided improved clinical quality of care. Catheter ablation may be considered early in the course of treatment of this tachyarrhythmia in symptomatic patients.

Risks from Catheter Ablation of Atrial Fibrillation: A Review of Methods, Efficacy, and Safety.

Atrial fibrillation (AF) is the most common arrhythmia and is a significant burden to healthcare cost. AF causes congestive heart failure, thromboembolic events such as stroke and intolerable symptoms in some patients. With the advances and increasing experience in catheter ablation, there is now an established role for catheter ablation in patients with atrial fibrillation. The risks, complications and patient features associated with it are increasingly recognized. A recent worldwide survey has shown an increasing number of medical centers that are practicing catheter ablation of atrial fibrillation, predominantly with pulmonary vein isolation techniques. However, catheter ablation is an invasive therapy in AF and is associated with a few major complications. Patient selection, ablation technique, and catheter energy source all influence the efficacy and safety of the procedure. Finally, while several randomized control trials have compared the efficacy of catheter ablation versus antiarrhythmic drug therapy, a number of trials are on the horizon to explore its role as a first line therapy for atrial fibrillation. New energy catheter energy sources are also being explored.

Electrophysiologic characteristics and radiofrequency ablation of focal atrial tachycardia arising from non-coronary sinuses of Valsalva in the aorta

Focal atrial tachycardia (AT) arising from non-coronary cusp (NCC) is very rare, and the experience in catheter ablation of this kind of tachycardia remains limited. This study describes the electrophysiologic characteristics and radiofrequency ablation of AT arising from NCC. The study population consisted of five consecutive patients (three females and two males; age 37-68 years) with AT arising from NCC. The morphology of P waves was described as positive, negative, isoelectric, or biphasic (positive-negative or negative-positive). The atrial mapping was performed during tachycardia to define the earliest atrial activation site. Mean tachycardia cycle length of AT in five patients was 363 +/- 44 ms. P-wave morphology was predominantly upright or biphasic in lead II, III, and aVF, inverted in aVR. Positive P-wave morphology was seen in lead aVL in all five patients. The precordial leads were negative-positive in V(1) and V(2), negative-positive or positive in lead V(3)-V(5), and positive in lead V(6). All the five patients underwent successful radiofrequency ablation within NCC. During a follow up of > 3 months, no patient presented with a recurrence. This study demonstrated that mapping and ablation of focal AT arising from NCC is safe and effective. When earliest activation was recorded in the proximal electrode of the His-bundle catheter, but radiofrequency ablation in this region cannot successfully eliminated the tachycardia, the AT should be considered to arise from NCC especially when P-wave morphology was initially negative with a late positive component in right precordial leads, upright or biphasic in inferior leads.

Catheter ablation of arrhythmic storm triggered by monomorphic ectopic beats in patients with coronary artery disease

Frequent episodes of polymorphic ventricular tachycardias/ventricular fibrillation (VT/VF) in patients with coronary artery disease can be triggered by monomorphic ventricular premature beats (VPBs) and thus, amenable to catheter ablation. The goal of this study was to review single-center experience in catheter ablation of electrical storm caused by focally triggered polymorphic VT/VF. Catheter ablation of electrical storm due to focally triggered polymorphic VT/VF was performed in nine patients (mean age, 62+/-7 years; two females). All patients had previous myocardial infarction (interval of 3 days to 171 months). Mean left ventricular ejection fraction was 27+/-6 percent. All patients presented with repeated runs of polymorphic VT/VF triggered by monomorphic VPBs. Based on mapping data, the ectopic beats originated from scar border zone on interventricular septum (n=5), inferior wall (n=3), and lateral wall (n=1). Catheter ablation was performed to abolish the triggering ectopy and to modify the arrhythmogenic substrate by linear lesions within the infarct border zone. The ablation procedure was acutely successful in eight out of nine patients. During the follow-up of 13+/-7 months, two patients died due to progressive heart failure. One patient had late recurrence of electrical storm due to ectopic beats of different morphology and was successfully reablated. Electrical storm due to focally triggered polymorphic VT/VF may occur either in subacute phase of myocardial infarction or substantially later after index event. Catheter ablation of ectopic beats triggering these arrhythmias can successfully abolish electrical storm and become a life-saving procedure.

Catheter ablation of left atrial focal tachycardia guided by electroanatomic mapping and new insights into interatrial electrical conduction

Experience in catheter ablation of left atrial (LA) focal tachycardia and information about interatrial electrical connections during LA focal tachycardia are limited. The purpose of this study was to describe our experience in electroanatomic mapping-guided catheter ablation of LA focal tachycardia and to investigate interatrial electrical connections during LA focal tachycardias. Thirty-three patients undergoing catheter ablation for LA focal tachycardia guided by electroanatomic mapping were reported. Interatrial electrical connections were analyzed in LA focal tachycardias with biatrial electroanatomic maps. Of the 35 LA focal tachycardias (cycle length 309 +/- 100 ms) mapped, 19 (54%) originated from the pulmonary veins (PVs), 6 (17%) from the mitral annulus, 3 (8.6%) from LA roof, 3 (8.6%) from LA posterior wall, 2 (5.7%) from LA appendage, and 2 (5.7%) from LA septum. Fourteen of the 19 PV tachycardias (74%) were located in proximity to PV ostia. In 14 (7 PV, 7 non-PV) LA focal tachycardias with biatrial electroanatomic maps, posterior right atrium breakthrough sites at the intercaval area were identified in 7 PV tachycardias and 1 non-PV tachycardia. Five of the 7 PV tachycardias used only the posterior breakthrough for interatrial propagation. Procedural success was achieved in 33 of 35 LA focal tachycardias (94%) in 31 patients. During 23 +/- 19 months of follow-up, 2 patients (6%) had recurrence of ablated tachycardia, and 3 (10%) developed new LA focal tachycardias. The PVs and the mitral annulus were the main sources of LA focal tachycardias. The majority of PV tachycardias originated from PV ostia. A posterior interatrial connection appeared to play a major role in interatrial electrical propagation during PV tachycardias. Electroanatomic mapping facilitated precise localization of LA focal tachycardias and achievement of a high rate of ablation success.