Initial Human Feasibility of Infusion Needle Catheter Ablation for Refractory Ventricular Tachycardia
| Autor: | William G. Stevenson, Vikas Kuriachan, Ratika Parkash, Christopher Beeckler, John L. Sapp, Chris Gray, Katja Zeppenfeld, Robert W. Pike |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2013 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent medicine.medical_treatment Perforation (oil well) Drug Resistance Catheter ablation Ventricular tachycardia tachycardia Iodinated contrast Recurrence Physiology (medical) Internal medicine catheter ablation medicine Humans Saline Aged Ejection fraction business.industry Middle Aged Ablation medicine.disease Surgery Catheter ventricular Treatment Outcome Needles Cardiology Tachycardia Ventricular Feasibility Studies Female Cardiology and Cardiovascular Medicine business Anti-Arrhythmia Agents Follow-Up Studies |
| Zdroj: | Circulation, 128(21), 2289-2295 |
| DOI: | 10.1161/circulationaha.113.003423 |
| Popis: | Background— Ablation of ventricular tachycardia (VT) is sometimes unsuccessful when ablation lesions are of insufficient depth to reach arrhythmogenic substrate. We report the initial experience with the use of a catheter with an extendable/retractable irrigated needle at the tip capable of intramyocardial mapping and ablation. Methods and Results— Sequential consenting patients with recurrent VT underwent ablation with the use of a needle-tipped catheter. At target sites, the needle was advanced 7 to 9 mm into the myocardium, permitting pacing and recording. Infusion of saline/iodinated contrast mixture excluded perforation and ensured intramyocardial deployment. Further infusion was delivered before and during temperature-controlled radiofrequency energy delivery through the needle. All 8 patients included (6 male; mean age, 54) with a mean left ventricular ejection fraction of 29% were refractory to multiple antiarrhythmic drugs, and 1 to 4 previous catheter ablation attempts (epicardial in 4) had failed. Patients had 1 to 7 (median, 2) VTs present or inducible; 2 were incessant. Some intramyocardial VT mapping was possible in 7 patients. A mean of 22 (limits, 3–48) needle ablation lesions were applied in 8 patients. All patients had at least 1 VT terminated or rendered noninducible. During a median of 12 months follow-up, 4 patients were free of recurrent VT, and 3 patients were improved, but had new VTs occur at some point during follow-up. Two died of the progression of preexisting heart failure without recurrent VT. Complications included tamponade in 1 patient and heart block in 2 patients. Conclusions— Intramyocardial infusion-needle catheter ablation is feasible and permits control of some VTs that have been refractory to conventional catheter ablation therapy, warranting further study. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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