Surgical ablation of refractory ventricular tachycardia in patients with nonischemic cardiomyopathy

Elad Anter, Mathew D. Hutchinson, Rajat Deo, Haris M. Haqqani, David J. Callans, Edward P. Gerstenfeld, Fermin C. Garcia, Rupa Bala, David Lin, Michael P. Riley, Harold I. Litt, Joseph Y. Woo, Michael A. Acker, Wilson Y. Szeto, Erica S. Zado, Francis E. Marchlinski, Sanjay Dixit

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Background-The surgical approach for the treatment of ventricular tachycardia (VT) has been largely replaced by percutaneous, catheter-based techniques. However, some VT circuits, particularly in patients with nonischemic cardiomyopathy, remain inaccessible to percutaneous ablation. Surgical therapy of these VTs is an alternative approach; however, its methodology has not been well defined. The purpose of this study was to evaluate the efficacy of preoperative electroanatomic and electrophysiological characterization of the VT substrate and circuit to guide surgical ablation. Methods and Results-Eight patients with recurrent sustained VT refractory to antiarrhythmic drugs underwent endocardial and/or epicardial ablation procedures. Electroanatomic mapping was performed, and the VT substrate and circuit(s) were defined using voltage, activation, entrainment, and pace mapping. All 8 patients underwent detailed endocardial mapping; 6 patients also underwent epicardial mapping. Radiofrequency ablation was performed with the use of an open-irrigation catheter. After the unsuccessful percutaneous approach, surgical cryoablation was applied to the sites previously identified and targeted during the percutaneous procedure. There were no significant perioperative complications. During a mean follow-up period of 23±6 months (range, 15 to 34 months), 6 patients had significant reduction in VT burden as evident by a reduced number of implantable cardioverter-defibrillator shocks after ablation (6.6 to 0.6 shocks per patient; P=0.026). Two patients died, one of progressive heart failure and one of sepsis. Conclusions-VT circuits inaccessible to percutaneous ablation techniques are rare but can be encountered in patients with nonischemic cardiomyopathy. These VTs can be successfully targeted by surgical cryoablation guided by preoperative electroanatomic and electrophysiological mapping.

Original languageEnglish (US)
Pages (from-to)494-500
Number of pages7
JournalCirculation: Arrhythmia and Electrophysiology
Volume4
Issue number4
DOIs
StatePublished - Aug 2011
Externally publishedYes

Fingerprint

Ventricular Tachycardia
Cardiomyopathies
Cryosurgery
Shock
Catheters
Epicardial Mapping
Ablation Techniques
Implantable Defibrillators
Anti-Arrhythmia Agents
Sepsis
Heart Failure
Therapeutics

Keywords

  • Catheter ablation
  • Cryoablation
  • Surgical ablation
  • Ventricular tachycardia

ASJC Scopus subject areas

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

Cite this

Anter, E., Hutchinson, M. D., Deo, R., Haqqani, H. M., Callans, D. J., Gerstenfeld, E. P., ... Dixit, S. (2011). Surgical ablation of refractory ventricular tachycardia in patients with nonischemic cardiomyopathy. Circulation: Arrhythmia and Electrophysiology, 4(4), 494-500. https://doi.org/10.1161/CIRCEP.111.962555

Surgical ablation of refractory ventricular tachycardia in patients with nonischemic cardiomyopathy. / Anter, Elad; Hutchinson, Mathew D.; Deo, Rajat; Haqqani, Haris M.; Callans, David J.; Gerstenfeld, Edward P.; Garcia, Fermin C.; Bala, Rupa; Lin, David; Riley, Michael P.; Litt, Harold I.; Woo, Joseph Y.; Acker, Michael A.; Szeto, Wilson Y.; Zado, Erica S.; Marchlinski, Francis E.; Dixit, Sanjay.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 4, No. 4, 08.2011, p. 494-500.

Research output: Contribution to journalArticle

Anter, E, Hutchinson, MD, Deo, R, Haqqani, HM, Callans, DJ, Gerstenfeld, EP, Garcia, FC, Bala, R, Lin, D, Riley, MP, Litt, HI, Woo, JY, Acker, MA, Szeto, WY, Zado, ES, Marchlinski, FE & Dixit, S 2011, 'Surgical ablation of refractory ventricular tachycardia in patients with nonischemic cardiomyopathy', Circulation: Arrhythmia and Electrophysiology, vol. 4, no. 4, pp. 494-500. https://doi.org/10.1161/CIRCEP.111.962555
Anter, Elad ; Hutchinson, Mathew D. ; Deo, Rajat ; Haqqani, Haris M. ; Callans, David J. ; Gerstenfeld, Edward P. ; Garcia, Fermin C. ; Bala, Rupa ; Lin, David ; Riley, Michael P. ; Litt, Harold I. ; Woo, Joseph Y. ; Acker, Michael A. ; Szeto, Wilson Y. ; Zado, Erica S. ; Marchlinski, Francis E. ; Dixit, Sanjay. / Surgical ablation of refractory ventricular tachycardia in patients with nonischemic cardiomyopathy. In: Circulation: Arrhythmia and Electrophysiology. 2011 ; Vol. 4, No. 4. pp. 494-500.
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abstract = "Background-The surgical approach for the treatment of ventricular tachycardia (VT) has been largely replaced by percutaneous, catheter-based techniques. However, some VT circuits, particularly in patients with nonischemic cardiomyopathy, remain inaccessible to percutaneous ablation. Surgical therapy of these VTs is an alternative approach; however, its methodology has not been well defined. The purpose of this study was to evaluate the efficacy of preoperative electroanatomic and electrophysiological characterization of the VT substrate and circuit to guide surgical ablation. Methods and Results-Eight patients with recurrent sustained VT refractory to antiarrhythmic drugs underwent endocardial and/or epicardial ablation procedures. Electroanatomic mapping was performed, and the VT substrate and circuit(s) were defined using voltage, activation, entrainment, and pace mapping. All 8 patients underwent detailed endocardial mapping; 6 patients also underwent epicardial mapping. Radiofrequency ablation was performed with the use of an open-irrigation catheter. After the unsuccessful percutaneous approach, surgical cryoablation was applied to the sites previously identified and targeted during the percutaneous procedure. There were no significant perioperative complications. During a mean follow-up period of 23±6 months (range, 15 to 34 months), 6 patients had significant reduction in VT burden as evident by a reduced number of implantable cardioverter-defibrillator shocks after ablation (6.6 to 0.6 shocks per patient; P=0.026). Two patients died, one of progressive heart failure and one of sepsis. Conclusions-VT circuits inaccessible to percutaneous ablation techniques are rare but can be encountered in patients with nonischemic cardiomyopathy. These VTs can be successfully targeted by surgical cryoablation guided by preoperative electroanatomic and electrophysiological mapping.",
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AU - Anter, Elad

AU - Hutchinson, Mathew D.

AU - Deo, Rajat

AU - Haqqani, Haris M.

AU - Callans, David J.

AU - Gerstenfeld, Edward P.

AU - Garcia, Fermin C.

AU - Bala, Rupa

AU - Lin, David

AU - Riley, Michael P.

AU - Litt, Harold I.

AU - Woo, Joseph Y.

AU - Acker, Michael A.

AU - Szeto, Wilson Y.

AU - Zado, Erica S.

AU - Marchlinski, Francis E.

AU - Dixit, Sanjay

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N2 - Background-The surgical approach for the treatment of ventricular tachycardia (VT) has been largely replaced by percutaneous, catheter-based techniques. However, some VT circuits, particularly in patients with nonischemic cardiomyopathy, remain inaccessible to percutaneous ablation. Surgical therapy of these VTs is an alternative approach; however, its methodology has not been well defined. The purpose of this study was to evaluate the efficacy of preoperative electroanatomic and electrophysiological characterization of the VT substrate and circuit to guide surgical ablation. Methods and Results-Eight patients with recurrent sustained VT refractory to antiarrhythmic drugs underwent endocardial and/or epicardial ablation procedures. Electroanatomic mapping was performed, and the VT substrate and circuit(s) were defined using voltage, activation, entrainment, and pace mapping. All 8 patients underwent detailed endocardial mapping; 6 patients also underwent epicardial mapping. Radiofrequency ablation was performed with the use of an open-irrigation catheter. After the unsuccessful percutaneous approach, surgical cryoablation was applied to the sites previously identified and targeted during the percutaneous procedure. There were no significant perioperative complications. During a mean follow-up period of 23±6 months (range, 15 to 34 months), 6 patients had significant reduction in VT burden as evident by a reduced number of implantable cardioverter-defibrillator shocks after ablation (6.6 to 0.6 shocks per patient; P=0.026). Two patients died, one of progressive heart failure and one of sepsis. Conclusions-VT circuits inaccessible to percutaneous ablation techniques are rare but can be encountered in patients with nonischemic cardiomyopathy. These VTs can be successfully targeted by surgical cryoablation guided by preoperative electroanatomic and electrophysiological mapping.

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KW - Cryoablation

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