Long-term outcomes of combined epicardial and endocardial ablation of monomorphic ventricular tachycardia related to hypertrophic cardiomyopathy

Srinivas R. Dukkipati, Andre D'Avila, Kyoko Soejima, Rupa Bala, Keiichi Inada, Sheldon Singh, William G. Stevenson, Francis E. Marchlinski, Vivek Y. Reddy

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

Background - Monomorphic ventricular tachycardia (MMVT) is rare in patients with hypertrophic cardiomyopathy (HCM). There are limited data on the utility of catheter ablation for the treatment of MMVT in this population. This study details a series of case reports from multiple centers where combined epicardial-endocardial ablation was performed in a highly selected group of patients with HCM-related MMVT. Methods and Results - The cohort consisted of 10 patients with HCM-related MMVT. Pericardial access was achieved using the percutaneous subxyphoid approach. Epicardial and endocardial ventricular 3D bipolar voltage maps were generated. Ablation sites were identified using a combination of entrainment, activation, late/fractionated potential, and pace mapping. Electrophysiological-identified epicardial scar was present in 8 (80%) patients, endocardial scar in 6 (60%), and no scar in 1 (10%). In the 5 patients with inducible, stable MMVT, 3 cases were successfully terminated with ablation from the epicardium and 1 from the endocardium. The case that failed catheter ablation required surgical cryoablation to abolish the incessant VT. In the remaining 5 patients, 4 underwent epicardial and endocardial ablation of sites with good pace maps and late/fractionated potentials. No ablation was performed in the remaining patient because of noninducibility and lack of identifiable scar. After 37±17 months (limits, 2 to 62 months; median, 37 months), the freedom from recurrent implantable cardioverter-defibrillator shocks was 78% (7/9 patients) in those who underwent ablation. Conclusions - In highly selected patients with HCM, combined epicardial and endocardial mapping and ablation is a feasible and reasonably efficacious option for MMVT if refractory to aggressive trials of antiarrhythmic drugs and antitachycardia pacing.

Original languageEnglish (US)
Pages (from-to)185-194
Number of pages10
JournalCirculation: Arrhythmia and Electrophysiology
Volume4
Issue number2
DOIs
StatePublished - Apr 2011
Externally publishedYes

Fingerprint

Hypertrophic Cardiomyopathy
Ventricular Tachycardia
Cicatrix
Catheter Ablation
Epicardial Mapping
Endocardium
Cryosurgery
Implantable Defibrillators
Pericardium
Anti-Arrhythmia Agents
Shock

Keywords

  • Ablation
  • Arrhythmia
  • Cardiomyopathy hypertrophic
  • Epicardial mapping

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Long-term outcomes of combined epicardial and endocardial ablation of monomorphic ventricular tachycardia related to hypertrophic cardiomyopathy. / Dukkipati, Srinivas R.; D'Avila, Andre; Soejima, Kyoko; Bala, Rupa; Inada, Keiichi; Singh, Sheldon; Stevenson, William G.; Marchlinski, Francis E.; Reddy, Vivek Y.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 4, No. 2, 04.2011, p. 185-194.

Research output: Contribution to journalArticle

Dukkipati, Srinivas R. ; D'Avila, Andre ; Soejima, Kyoko ; Bala, Rupa ; Inada, Keiichi ; Singh, Sheldon ; Stevenson, William G. ; Marchlinski, Francis E. ; Reddy, Vivek Y. / Long-term outcomes of combined epicardial and endocardial ablation of monomorphic ventricular tachycardia related to hypertrophic cardiomyopathy. In: Circulation: Arrhythmia and Electrophysiology. 2011 ; Vol. 4, No. 2. pp. 185-194.
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abstract = "Background - Monomorphic ventricular tachycardia (MMVT) is rare in patients with hypertrophic cardiomyopathy (HCM). There are limited data on the utility of catheter ablation for the treatment of MMVT in this population. This study details a series of case reports from multiple centers where combined epicardial-endocardial ablation was performed in a highly selected group of patients with HCM-related MMVT. Methods and Results - The cohort consisted of 10 patients with HCM-related MMVT. Pericardial access was achieved using the percutaneous subxyphoid approach. Epicardial and endocardial ventricular 3D bipolar voltage maps were generated. Ablation sites were identified using a combination of entrainment, activation, late/fractionated potential, and pace mapping. Electrophysiological-identified epicardial scar was present in 8 (80{\%}) patients, endocardial scar in 6 (60{\%}), and no scar in 1 (10{\%}). In the 5 patients with inducible, stable MMVT, 3 cases were successfully terminated with ablation from the epicardium and 1 from the endocardium. The case that failed catheter ablation required surgical cryoablation to abolish the incessant VT. In the remaining 5 patients, 4 underwent epicardial and endocardial ablation of sites with good pace maps and late/fractionated potentials. No ablation was performed in the remaining patient because of noninducibility and lack of identifiable scar. After 37±17 months (limits, 2 to 62 months; median, 37 months), the freedom from recurrent implantable cardioverter-defibrillator shocks was 78{\%} (7/9 patients) in those who underwent ablation. Conclusions - In highly selected patients with HCM, combined epicardial and endocardial mapping and ablation is a feasible and reasonably efficacious option for MMVT if refractory to aggressive trials of antiarrhythmic drugs and antitachycardia pacing.",
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AU - Dukkipati, Srinivas R.

AU - D'Avila, Andre

AU - Soejima, Kyoko

AU - Bala, Rupa

AU - Inada, Keiichi

AU - Singh, Sheldon

AU - Stevenson, William G.

AU - Marchlinski, Francis E.

AU - Reddy, Vivek Y.

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AB - Background - Monomorphic ventricular tachycardia (MMVT) is rare in patients with hypertrophic cardiomyopathy (HCM). There are limited data on the utility of catheter ablation for the treatment of MMVT in this population. This study details a series of case reports from multiple centers where combined epicardial-endocardial ablation was performed in a highly selected group of patients with HCM-related MMVT. Methods and Results - The cohort consisted of 10 patients with HCM-related MMVT. Pericardial access was achieved using the percutaneous subxyphoid approach. Epicardial and endocardial ventricular 3D bipolar voltage maps were generated. Ablation sites were identified using a combination of entrainment, activation, late/fractionated potential, and pace mapping. Electrophysiological-identified epicardial scar was present in 8 (80%) patients, endocardial scar in 6 (60%), and no scar in 1 (10%). In the 5 patients with inducible, stable MMVT, 3 cases were successfully terminated with ablation from the epicardium and 1 from the endocardium. The case that failed catheter ablation required surgical cryoablation to abolish the incessant VT. In the remaining 5 patients, 4 underwent epicardial and endocardial ablation of sites with good pace maps and late/fractionated potentials. No ablation was performed in the remaining patient because of noninducibility and lack of identifiable scar. After 37±17 months (limits, 2 to 62 months; median, 37 months), the freedom from recurrent implantable cardioverter-defibrillator shocks was 78% (7/9 patients) in those who underwent ablation. Conclusions - In highly selected patients with HCM, combined epicardial and endocardial mapping and ablation is a feasible and reasonably efficacious option for MMVT if refractory to aggressive trials of antiarrhythmic drugs and antitachycardia pacing.

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