Empiric ablation of polymorphic ventricular tachycardia/fibrillation in the absence of a mappable trigger: Prospective feasibility and efficacy of pacemap matching to defibrillator electrograms
| Autor: | Dalise Y. Shatz, Roderick Tung, Stephanie A. Besser, Gaurav A. Upadhyay, Andrew D. Beaser, Zaid Aziz, Pablo Salazar, Hemal M. Nayak |
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| Rok vydání: | 2022 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Catheter ablation Ventricular tachycardia Physiology (medical) Internal medicine medicine Humans Prospective Studies Moderator band Papillary muscle Fibrillation business.industry Implantable cardioverter-defibrillator medicine.disease Ventricular Premature Complexes Defibrillators Implantable medicine.anatomical_structure Ventricular Fibrillation Ventricular fibrillation Catheter Ablation Tachycardia Ventricular Cardiology Feasibility Studies medicine.symptom Electrical conduction system of the heart Cardiology and Cardiovascular Medicine business |
| Zdroj: | Heart Rhythm. 19:527-535 |
| ISSN: | 1547-5271 |
| Popis: | Background Catheter ablation strategies for ventricular fibrillation (VF) and polymorphic ventricular tachycardia (PMVT) are not established when spontaneous triggers are rare or absent. Objective The purpose of this study was to report the feasibility and efficacy of a novel empiric ablation strategy of pacemapping to stored implantable cardioverter-defibrillator (ICD) template electrograms (SITE) of the clinical premature ventricular contraction (PVC) trigger. Methods Fifteen patients with drug-refractory VF/PMVT receiving defibrillator shocks without identifiable and mappable PVC triggers were prospectively analyzed. The protocol incorporated systematic pacemapping from known arrhythmogenic sites (moderator band/right ventricular [RV] papillary muscles, left conduction system/Purkinje network, outflow tracts) with real-time comparison between the paced ICD electrogram (EGM) morphology and SITE. Results Regions within the left Purkinje network yielded the best pacemap match for the SITE of the clinical PVC trigger in 55% of ablation targets (left posterior fascicle 6, left septal fascicle 1, left anterior fascicle 5), followed by the RV moderator band region in 14% (n = 3), RV papillary muscles in 13% (n = 3), periaortic region in 14% (n = 3), and left ventricular anterolateral papillary muscle in 4% (n = 1). Freedom from ICD therapies off antiarrhythmic drug (AAD) was 64% at 6 months and 48% at 12 months. Shock burden was reduced from 4 (2–6) to 0 (0–1) (P = .001), and use of AADs was reduced from 2 (1–2) to 0 (0–1) (P = .001). Conclusion In the absence of a mappable trigger, an empiric strategy of interrogating the Purkinje network, papillary muscles, and outflow tract regions by pacemap matching with SITE of the clinical PVC is feasible to guide ablation. A significant reduction in VF/PMVT therapy burden and AAD utilization was observed after a single procedure. |
| Databáze: | OpenAIRE |
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