Safety of radiofrequency catheter ablation without coronary angiography in aortic cusp ventricular arrhythmias

Kurt S. Hoffmayer, Thomas Dewland, Henry H. Hsia, Nitish Badhwar, Jonathan C. Hsu, Zian H. Tseng, Gregory M. Marcus, Melvin M. Scheinman, Edward P. Gerstenfeld

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background Ventricular arrhythmias (VAs) originating from the aortic root are common. Coronary angiography is typically recommended before catheter ablation to document proximity of the ablation catheter to the coronary ostia. Objective To investigate how often catheter ablation in the aortic root could be guided by phased-array intracardiac echocardiography (ICE) and electroanatomic mapping without requiring aortography or coronary angiography. Methods We reviewed consecutive patients referred for aortic root VAs to operators experienced in the use of ICE at a single center. An ICE catheter and a 3.5-mm irrigated ablation catheter were used in all cases, and the need for angiography before ablation was documented. Acute success and acute and 30-day complications were noted. Results Thirty-five patients (age 58 ± 13 years; 74% men) were referred for the ablation of VAs; 32 of 35 (91%) underwent ablation using ICE and 3-dimensional mapping without the need for coronary angiography. Successful acute ablation was achieved in 29 of 35 (83%) patients. In all cases, the catheter tip was directly visualized with ICE >1 cm from the coronary ostia. The site of origin of the earliest VA was the left cusp (17 of 35 [49%]), right cusp (9 of 35 [26%]), right-left cusp junction (8 of 35 [23%]), or right-noncoronary cusp junction (1 of 35 [3%]). There were no cases of coronary injury, embolic stroke, aortic root perforation, worsening of aortic regurgitation, or death acutely or at 30 days. Conclusion Radiofrequency ablation of VAs originating from the aortic root may be safely performed using ICE and electroanatomic mapping in the majority of cases without the need for coronary angiography.

Original languageEnglish (US)
Pages (from-to)1117-1121
Number of pages5
JournalHeart Rhythm
Volume11
Issue number7
DOIs
StatePublished - 2014
Externally publishedYes

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Catheter Ablation
Coronary Angiography
Echocardiography
Cardiac Arrhythmias
Safety
Cardiac Catheters
Aortography
Aortic Valve Insufficiency
Angiography
Catheters
Stroke
Wounds and Injuries

Keywords

  • Aortic cusp
  • Catheter ablation
  • Premature ventricular contractions
  • Ventricular tachycardia

ASJC Scopus subject areas

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

Cite this

Hoffmayer, K. S., Dewland, T., Hsia, H. H., Badhwar, N., Hsu, J. C., Tseng, Z. H., ... Gerstenfeld, E. P. (2014). Safety of radiofrequency catheter ablation without coronary angiography in aortic cusp ventricular arrhythmias. Heart Rhythm, 11(7), 1117-1121. https://doi.org/10.1016/j.hrthm.2014.04.019

Safety of radiofrequency catheter ablation without coronary angiography in aortic cusp ventricular arrhythmias. / Hoffmayer, Kurt S.; Dewland, Thomas; Hsia, Henry H.; Badhwar, Nitish; Hsu, Jonathan C.; Tseng, Zian H.; Marcus, Gregory M.; Scheinman, Melvin M.; Gerstenfeld, Edward P.

In: Heart Rhythm, Vol. 11, No. 7, 2014, p. 1117-1121.

Research output: Contribution to journalArticle

Hoffmayer, KS, Dewland, T, Hsia, HH, Badhwar, N, Hsu, JC, Tseng, ZH, Marcus, GM, Scheinman, MM & Gerstenfeld, EP 2014, 'Safety of radiofrequency catheter ablation without coronary angiography in aortic cusp ventricular arrhythmias', Heart Rhythm, vol. 11, no. 7, pp. 1117-1121. https://doi.org/10.1016/j.hrthm.2014.04.019
Hoffmayer, Kurt S. ; Dewland, Thomas ; Hsia, Henry H. ; Badhwar, Nitish ; Hsu, Jonathan C. ; Tseng, Zian H. ; Marcus, Gregory M. ; Scheinman, Melvin M. ; Gerstenfeld, Edward P. / Safety of radiofrequency catheter ablation without coronary angiography in aortic cusp ventricular arrhythmias. In: Heart Rhythm. 2014 ; Vol. 11, No. 7. pp. 1117-1121.
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abstract = "Background Ventricular arrhythmias (VAs) originating from the aortic root are common. Coronary angiography is typically recommended before catheter ablation to document proximity of the ablation catheter to the coronary ostia. Objective To investigate how often catheter ablation in the aortic root could be guided by phased-array intracardiac echocardiography (ICE) and electroanatomic mapping without requiring aortography or coronary angiography. Methods We reviewed consecutive patients referred for aortic root VAs to operators experienced in the use of ICE at a single center. An ICE catheter and a 3.5-mm irrigated ablation catheter were used in all cases, and the need for angiography before ablation was documented. Acute success and acute and 30-day complications were noted. Results Thirty-five patients (age 58 ± 13 years; 74{\%} men) were referred for the ablation of VAs; 32 of 35 (91{\%}) underwent ablation using ICE and 3-dimensional mapping without the need for coronary angiography. Successful acute ablation was achieved in 29 of 35 (83{\%}) patients. In all cases, the catheter tip was directly visualized with ICE >1 cm from the coronary ostia. The site of origin of the earliest VA was the left cusp (17 of 35 [49{\%}]), right cusp (9 of 35 [26{\%}]), right-left cusp junction (8 of 35 [23{\%}]), or right-noncoronary cusp junction (1 of 35 [3{\%}]). There were no cases of coronary injury, embolic stroke, aortic root perforation, worsening of aortic regurgitation, or death acutely or at 30 days. Conclusion Radiofrequency ablation of VAs originating from the aortic root may be safely performed using ICE and electroanatomic mapping in the majority of cases without the need for coronary angiography.",
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T1 - Safety of radiofrequency catheter ablation without coronary angiography in aortic cusp ventricular arrhythmias

AU - Hoffmayer, Kurt S.

AU - Dewland, Thomas

AU - Hsia, Henry H.

AU - Badhwar, Nitish

AU - Hsu, Jonathan C.

AU - Tseng, Zian H.

AU - Marcus, Gregory M.

AU - Scheinman, Melvin M.

AU - Gerstenfeld, Edward P.

PY - 2014

Y1 - 2014

N2 - Background Ventricular arrhythmias (VAs) originating from the aortic root are common. Coronary angiography is typically recommended before catheter ablation to document proximity of the ablation catheter to the coronary ostia. Objective To investigate how often catheter ablation in the aortic root could be guided by phased-array intracardiac echocardiography (ICE) and electroanatomic mapping without requiring aortography or coronary angiography. Methods We reviewed consecutive patients referred for aortic root VAs to operators experienced in the use of ICE at a single center. An ICE catheter and a 3.5-mm irrigated ablation catheter were used in all cases, and the need for angiography before ablation was documented. Acute success and acute and 30-day complications were noted. Results Thirty-five patients (age 58 ± 13 years; 74% men) were referred for the ablation of VAs; 32 of 35 (91%) underwent ablation using ICE and 3-dimensional mapping without the need for coronary angiography. Successful acute ablation was achieved in 29 of 35 (83%) patients. In all cases, the catheter tip was directly visualized with ICE >1 cm from the coronary ostia. The site of origin of the earliest VA was the left cusp (17 of 35 [49%]), right cusp (9 of 35 [26%]), right-left cusp junction (8 of 35 [23%]), or right-noncoronary cusp junction (1 of 35 [3%]). There were no cases of coronary injury, embolic stroke, aortic root perforation, worsening of aortic regurgitation, or death acutely or at 30 days. Conclusion Radiofrequency ablation of VAs originating from the aortic root may be safely performed using ICE and electroanatomic mapping in the majority of cases without the need for coronary angiography.

AB - Background Ventricular arrhythmias (VAs) originating from the aortic root are common. Coronary angiography is typically recommended before catheter ablation to document proximity of the ablation catheter to the coronary ostia. Objective To investigate how often catheter ablation in the aortic root could be guided by phased-array intracardiac echocardiography (ICE) and electroanatomic mapping without requiring aortography or coronary angiography. Methods We reviewed consecutive patients referred for aortic root VAs to operators experienced in the use of ICE at a single center. An ICE catheter and a 3.5-mm irrigated ablation catheter were used in all cases, and the need for angiography before ablation was documented. Acute success and acute and 30-day complications were noted. Results Thirty-five patients (age 58 ± 13 years; 74% men) were referred for the ablation of VAs; 32 of 35 (91%) underwent ablation using ICE and 3-dimensional mapping without the need for coronary angiography. Successful acute ablation was achieved in 29 of 35 (83%) patients. In all cases, the catheter tip was directly visualized with ICE >1 cm from the coronary ostia. The site of origin of the earliest VA was the left cusp (17 of 35 [49%]), right cusp (9 of 35 [26%]), right-left cusp junction (8 of 35 [23%]), or right-noncoronary cusp junction (1 of 35 [3%]). There were no cases of coronary injury, embolic stroke, aortic root perforation, worsening of aortic regurgitation, or death acutely or at 30 days. Conclusion Radiofrequency ablation of VAs originating from the aortic root may be safely performed using ICE and electroanatomic mapping in the majority of cases without the need for coronary angiography.

KW - Aortic cusp

KW - Catheter ablation

KW - Premature ventricular contractions

KW - Ventricular tachycardia

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U2 - 10.1016/j.hrthm.2014.04.019

DO - 10.1016/j.hrthm.2014.04.019

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