Percutaneous epicardial ablation of ventricular arrhythmias arising from the left ventricular summit

Pasquale Santangeli; Francis E. Marchlinski; Erica S. Zado; Daniel Benhayon; Mathew D. Hutchinson; David Lin; David S. Frankel; Michael P. Riley; Gregory E. Supple; Fermin C. Garcia; Rupa Bala; Benoit Desjardins; David J. Callans; Sanjay Dixit

doi:10.1161/CIRCEP.114.002377

Percutaneous epicardial ablation of ventricular arrhythmias arising from the left ventricular summit

Pasquale Santangeli, Francis E. Marchlinski, Erica S. Zado, Daniel Benhayon, Mathew D. Hutchinson, David Lin, David S. Frankel, Michael P. Riley, Gregory E. Supple, Fermin C. Garcia, Rupa Bala, Benoit Desjardins, David J. Callans, Sanjay Dixit

Research output: Contribution to journal › Article › peer-review

128 Scopus citations

Abstract

Background-Percutaneous epicardial ablation of ventricular arrhythmias arising from the left ventricular summit is limited by the presence of major coronary vessels and epicardial fat. We report the outcomes of percutaneous epicardial mapping and ablation of ventricular arrhythmias arising from the left ventricular summit and the ECG features associated with successful ablation. Methods and Results-Between January 2003 and December 2012, a total of 23 consecutive patients (49±14 years; 39% men) with ventricular arrhythmias arising from the left ventricular summit underwent percutaneous epicardial instrumentation for mapping and ablation because of unsuccessful ablation from the coronary venous system and multiple endocardial LV/right ventricular sites. Successful epicardial ablation was achieved in 5 (22%) patients. In the remaining 18 (78%) cases, ablation was aborted for either close proximity to major coronary arteries or poor energy delivery over epicardial fat. The Q-wave amplitude ratio in aVL/aVR was higher in the successful group, with a ratio of >1.85 present in 4 (80%) patients in the successful group versus 2 (11%) in the unsuccessful group (P=0.008). The ratio of R/S wave in V1 was greater in the successful group, with 4 (80%) patients in the successful group having a R/S ratio of >2 in V1 versus 5 (28%) in the unsuccessful group (P=0.056). None of the patients in the successful group had an initial q wave in lead V1, as opposed to 6 (33%) in the unsuccessful group. The presence of at least 2 of the 3 ECG criteria above predicted successful ablation with 100% sensitivity and 72% specificity. Conclusions-Epicardial instrumentation for mapping and ablation of ventricular arrhythmias arising from the left ventricular summit is successful only in a minority of patients because of close proximity to major coronary arteries and epicardial fat. A Q-wave ratio of >1.85 in aVL/aVR, a R/S ratio of >2 in V1, and absence of q waves in lead V1 help identify appropriate candidates for epicardial ablation.

Original language	English (US)
Pages (from-to)	337-343
Number of pages	7
Journal	Circulation: Arrhythmia and Electrophysiology
Volume	8
Issue number	2
DOIs	https://doi.org/10.1161/CIRCEP.114.002377
State	Published - Apr 20 2015
Externally published	Yes

Keywords

catheter ablation
epicardial mapping
tachycardia, ventricular

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Physiology (medical)

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10.1161/CIRCEP.114.002377

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Santangeli, P., Marchlinski, F. E., Zado, E. S., Benhayon, D., Hutchinson, M. D., Lin, D., Frankel, D. S., Riley, M. P., Supple, G. E., Garcia, F. C., Bala, R., Desjardins, B., Callans, D. J., & Dixit, S. (2015). Percutaneous epicardial ablation of ventricular arrhythmias arising from the left ventricular summit. Circulation: Arrhythmia and Electrophysiology, 8(2), 337-343. https://doi.org/10.1161/CIRCEP.114.002377

Santangeli, P, Marchlinski, FE, Zado, ES, Benhayon, D, Hutchinson, MD, Lin, D, Frankel, DS, Riley, MP, Supple, GE, Garcia, FC, Bala, R, Desjardins, B, Callans, DJ & Dixit, S 2015, 'Percutaneous epicardial ablation of ventricular arrhythmias arising from the left ventricular summit', Circulation: Arrhythmia and Electrophysiology, vol. 8, no. 2, pp. 337-343. https://doi.org/10.1161/CIRCEP.114.002377

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title = "Percutaneous epicardial ablation of ventricular arrhythmias arising from the left ventricular summit",

abstract = "Background-Percutaneous epicardial ablation of ventricular arrhythmias arising from the left ventricular summit is limited by the presence of major coronary vessels and epicardial fat. We report the outcomes of percutaneous epicardial mapping and ablation of ventricular arrhythmias arising from the left ventricular summit and the ECG features associated with successful ablation. Methods and Results-Between January 2003 and December 2012, a total of 23 consecutive patients (49±14 years; 39% men) with ventricular arrhythmias arising from the left ventricular summit underwent percutaneous epicardial instrumentation for mapping and ablation because of unsuccessful ablation from the coronary venous system and multiple endocardial LV/right ventricular sites. Successful epicardial ablation was achieved in 5 (22%) patients. In the remaining 18 (78%) cases, ablation was aborted for either close proximity to major coronary arteries or poor energy delivery over epicardial fat. The Q-wave amplitude ratio in aVL/aVR was higher in the successful group, with a ratio of >1.85 present in 4 (80%) patients in the successful group versus 2 (11%) in the unsuccessful group (P=0.008). The ratio of R/S wave in V1 was greater in the successful group, with 4 (80%) patients in the successful group having a R/S ratio of >2 in V1 versus 5 (28%) in the unsuccessful group (P=0.056). None of the patients in the successful group had an initial q wave in lead V1, as opposed to 6 (33%) in the unsuccessful group. The presence of at least 2 of the 3 ECG criteria above predicted successful ablation with 100% sensitivity and 72% specificity. Conclusions-Epicardial instrumentation for mapping and ablation of ventricular arrhythmias arising from the left ventricular summit is successful only in a minority of patients because of close proximity to major coronary arteries and epicardial fat. A Q-wave ratio of >1.85 in aVL/aVR, a R/S ratio of >2 in V1, and absence of q waves in lead V1 help identify appropriate candidates for epicardial ablation.",

keywords = "catheter ablation, epicardial mapping, tachycardia, ventricular",

author = "Pasquale Santangeli and Marchlinski, {Francis E.} and Zado, {Erica S.} and Daniel Benhayon and Hutchinson, {Mathew D.} and David Lin and Frankel, {David S.} and Riley, {Michael P.} and Supple, {Gregory E.} and Garcia, {Fermin C.} and Rupa Bala and Benoit Desjardins and Callans, {David J.} and Sanjay Dixit",

note = "Publisher Copyright: {\textcopyright} 2015 American Heart Association, Inc.",

year = "2015",

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day = "20",

doi = "10.1161/CIRCEP.114.002377",

language = "English (US)",

volume = "8",

pages = "337--343",

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T1 - Percutaneous epicardial ablation of ventricular arrhythmias arising from the left ventricular summit

AU - Santangeli, Pasquale

AU - Marchlinski, Francis E.

AU - Zado, Erica S.

AU - Benhayon, Daniel

AU - Hutchinson, Mathew D.

AU - Lin, David

AU - Frankel, David S.

AU - Riley, Michael P.

AU - Supple, Gregory E.

AU - Garcia, Fermin C.

AU - Bala, Rupa

AU - Desjardins, Benoit

AU - Callans, David J.

AU - Dixit, Sanjay

PY - 2015/4/20

Y1 - 2015/4/20

N2 - Background-Percutaneous epicardial ablation of ventricular arrhythmias arising from the left ventricular summit is limited by the presence of major coronary vessels and epicardial fat. We report the outcomes of percutaneous epicardial mapping and ablation of ventricular arrhythmias arising from the left ventricular summit and the ECG features associated with successful ablation. Methods and Results-Between January 2003 and December 2012, a total of 23 consecutive patients (49±14 years; 39% men) with ventricular arrhythmias arising from the left ventricular summit underwent percutaneous epicardial instrumentation for mapping and ablation because of unsuccessful ablation from the coronary venous system and multiple endocardial LV/right ventricular sites. Successful epicardial ablation was achieved in 5 (22%) patients. In the remaining 18 (78%) cases, ablation was aborted for either close proximity to major coronary arteries or poor energy delivery over epicardial fat. The Q-wave amplitude ratio in aVL/aVR was higher in the successful group, with a ratio of >1.85 present in 4 (80%) patients in the successful group versus 2 (11%) in the unsuccessful group (P=0.008). The ratio of R/S wave in V1 was greater in the successful group, with 4 (80%) patients in the successful group having a R/S ratio of >2 in V1 versus 5 (28%) in the unsuccessful group (P=0.056). None of the patients in the successful group had an initial q wave in lead V1, as opposed to 6 (33%) in the unsuccessful group. The presence of at least 2 of the 3 ECG criteria above predicted successful ablation with 100% sensitivity and 72% specificity. Conclusions-Epicardial instrumentation for mapping and ablation of ventricular arrhythmias arising from the left ventricular summit is successful only in a minority of patients because of close proximity to major coronary arteries and epicardial fat. A Q-wave ratio of >1.85 in aVL/aVR, a R/S ratio of >2 in V1, and absence of q waves in lead V1 help identify appropriate candidates for epicardial ablation.

AB - Background-Percutaneous epicardial ablation of ventricular arrhythmias arising from the left ventricular summit is limited by the presence of major coronary vessels and epicardial fat. We report the outcomes of percutaneous epicardial mapping and ablation of ventricular arrhythmias arising from the left ventricular summit and the ECG features associated with successful ablation. Methods and Results-Between January 2003 and December 2012, a total of 23 consecutive patients (49±14 years; 39% men) with ventricular arrhythmias arising from the left ventricular summit underwent percutaneous epicardial instrumentation for mapping and ablation because of unsuccessful ablation from the coronary venous system and multiple endocardial LV/right ventricular sites. Successful epicardial ablation was achieved in 5 (22%) patients. In the remaining 18 (78%) cases, ablation was aborted for either close proximity to major coronary arteries or poor energy delivery over epicardial fat. The Q-wave amplitude ratio in aVL/aVR was higher in the successful group, with a ratio of >1.85 present in 4 (80%) patients in the successful group versus 2 (11%) in the unsuccessful group (P=0.008). The ratio of R/S wave in V1 was greater in the successful group, with 4 (80%) patients in the successful group having a R/S ratio of >2 in V1 versus 5 (28%) in the unsuccessful group (P=0.056). None of the patients in the successful group had an initial q wave in lead V1, as opposed to 6 (33%) in the unsuccessful group. The presence of at least 2 of the 3 ECG criteria above predicted successful ablation with 100% sensitivity and 72% specificity. Conclusions-Epicardial instrumentation for mapping and ablation of ventricular arrhythmias arising from the left ventricular summit is successful only in a minority of patients because of close proximity to major coronary arteries and epicardial fat. A Q-wave ratio of >1.85 in aVL/aVR, a R/S ratio of >2 in V1, and absence of q waves in lead V1 help identify appropriate candidates for epicardial ablation.

KW - catheter ablation

KW - epicardial mapping

KW - tachycardia, ventricular

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Percutaneous epicardial ablation of ventricular arrhythmias arising from the left ventricular summit

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