A 51-year old male who presented at our hospital for recurrent palpitation for several months was diagnosed dermatomyositis ten years ago and had interstitial lung disease since two years ago. Recently, he was admitte...A 51-year old male who presented at our hospital for recurrent palpitation for several months was diagnosed dermatomyositis ten years ago and had interstitial lung disease since two years ago. Recently, he was admitted for atypical hepatitis, and received maintenance treatment of oral corticosteroids.展开更多
Idiopathic monomorphic ventricular tachycardia and premature ventricular complexes (PVCs) commonly arise from the right and left ventricular outflow tracts (VOT). Their mechanism is most commonly triggered activity fr...Idiopathic monomorphic ventricular tachycardia and premature ventricular complexes (PVCs) commonly arise from the right and left ventricular outflow tracts (VOT). Their mechanism is most commonly triggered activity from delayed after-depolarizations and successful ablation is performed at the site of earliest endocardial activation. Re-entrant mechanisms have been rarely described. We report a case of an otherwise healthy patient who ultimately underwent six electro-physiology studies (EPS) and suffered numerous implantable cardiac defibrillator (ICD) discharges prior to the successful radiofrequency ablation (RFA) of two idiopathic VOT tachycardias. During the sixth EPS, a proximal aortogram demonstrated a left aortic sinus of valsalva (LASV) aneurysm. Subsequntly, a novel and successful RFA strategy of aneurysm isolation was undertaken. The presence of multiple clinical or inducible VT morphologies and the characterization of a VT as re-entrant should raise concerns that a complex arrhythmogenic substrate is present and defining the anatomy with angiography or an alternative imaging modality is essential in achieving a successful ablation strategy.展开更多
BACKGROUND With an increased number of surgical procedures involving the mitral annular region,the risk of mitral valve prolapse(MVP)has also increased.Previous studies have reported that worsening of MVP occurred ear...BACKGROUND With an increased number of surgical procedures involving the mitral annular region,the risk of mitral valve prolapse(MVP)has also increased.Previous studies have reported that worsening of MVP occurred early after radiofrequency catheter ablation(RFCA)at papillary muscles in ventricular tachycardia(VT)patients with preoperative MVP.CASE SUMMARY We report a case where MVP and papillary muscle rupture occurred 2 wk after RFCA in a papillary muscle originated VT patient without mitral valve regurgitation or prolapse before.The patient then underwent mitral valve replacement with no premature ventricular contraction or VT.During the surgery,a papillary muscle rupture was identified.Pathological examination showed necrosis of the papillary muscle.The patient recovered after mitral valve replacement.CONCLUSION Too many ablation procedures and energy should be avoided.展开更多
In patients with structural heart disease, ventricular tachycardia (VT) worsens the clinical condition and may severely affect the shortand long-term prognosis. Several therapeutic options can be considered for the ma...In patients with structural heart disease, ventricular tachycardia (VT) worsens the clinical condition and may severely affect the shortand long-term prognosis. Several therapeutic options can be considered for the management of this arrhythmia. Among others, catheter ablation, a closed-chest therapy, can prevent arrhythmia recurrences by abolishing the arrhythmogenic substrate. Over the last two decades, different techniques have been developed for an effective approach to both tolerated and untolerated VTs. The clinical outcome of patients undergoing ablation has been evaluated in multiple studies. This editorial gives an overview of the role, methodology, clinical outcome and innovative approaches in catheter ablation of VT.展开更多
Background Radiofrequency catheter ablation （RFCA） has been established as an effective and curative therapy for ventricular tachycardia （VT） and severely symptomatic premature ventricular contraction （PVC） from...Background Radiofrequency catheter ablation （RFCA） has been established as an effective and curative therapy for ventricular tachycardia （VT） and severely symptomatic premature ventricular contraction （PVC） from the outflow tract in structurally normal hearts. This study aimed to investigate electrophysiologic characteristics and effects of RFCA for patients with idiopathic VT and symptomatic PVC originating from the valve annulus. Methods Characteristics of body surface electrocardiogram （ECG） and endocardiogram in a successful RFCA target were analyzed in 16 patients with idiopathic VT and symptomatic PVC originating from the valve annulus. Additionally, the ECG characteristics of VT or PVC were compared with those of manifest Wolff-Parkinson-White （WPW） syndrome originating from the same site of origin in 15 patients. Results Thirteen patients were successful, 2 recurrent and 1 failed. The recurrent cases underwent successful ablation the second time guided by the Ensite 3000 mapping system. In all patients with the WPW syndrome, the characteristics of QRS morphology were well matched with those of the VT and PVC that originated from corresponding sites of origin. Conclusions RFCA is an effective curative therapy for VT and There are specific characteristics in ECG and the ablation site accessory pathway＇s algorithm. symptomatic PVC originating from the valve annulus. could be located by means of the WPW syndrome展开更多
Electrophysiology study and radiofrequency catheter ablation (RFCA) were performed in 26 patients with refractory sustained ventricular tachycardia (VT). After induction of VT, 12-lead electrocardiogram (ECG) was reco...Electrophysiology study and radiofrequency catheter ablation (RFCA) were performed in 26 patients with refractory sustained ventricular tachycardia (VT). After induction of VT, 12-lead electrocardiogram (ECG) was recorded and QRS morphology and axis of induced VT were studied to identify the origin of VT. The precise site of VT origin were localized by pace mapping and activation mapping carefully. RF energy was delivered through a big-tip deflectable electrode catheter when the earliest site of endocardial activation and a high-frequency and low-amplitude potential of Purkinje fiber, preceding surface QRS by more than 25 ms, were identified and / or a pace map was obtained showing identical QRS complexes in at least 11 of 12 ECG leads. VTs were ablated successfully in 24 of 26 patients (success rate was 92%). For successful ablation, it is essential that the pace map QRS morphology in 12 leads should be identical with that in spontaneous or induced VT as far as possible in performing pace mapping. Pace mapping is safe, simple and has no unfavourable effect on hemodynamics although it takes longer time. Activation mapping takes shorter time and has a high success rate. QRS configuration in spontaneous VT can help to localize the site of VT origin. Deliberate mapping at the site suggested to bo the origin of VT by surface ECG can shorten the duration of mapping and increase the success rate of RFCA. RFCA of VT in patients without structural heart disease is effective, safe, and has a high success rate, so it may be considered as an early therapy for these patients.展开更多
Background Verapamil-sensitive, idiopathic left ventricular tachycardia （ILVT） with right bundle branch block configuration and left-axis deviation is known to be due to re-entry mechanism but the exact nature of re...Background Verapamil-sensitive, idiopathic left ventricular tachycardia （ILVT） with right bundle branch block configuration and left-axis deviation is known to be due to re-entry mechanism but the exact nature of reentrant circuit in ILVT is not fully elucidated. Radiofrequency （RF） ablation was applied during ventricular tachycardia （VT） and termination of the VT or abolishing the inducibility of the tachycardia was used as an endpoint for successful RF. In this study, the left posterior fascicular block in surface electrocardiogram （ECG） was used as a new endpoint of ablation to cure ILVT. Methods Electrophysiological studies and radiofrequency ablation were performed in 39 consecutive patients [30 men, 9 women; age ranging from 10 to 64 years, mean （29± 16） years] with verapamil-sensitive ILVT and structurally normal hearts. VT could be terminated by the intravenous adininistration of verapamil in all patients. The target site was the midseptum of LV where the earliest Purkinje potentials were recorded during VT. RF current was applied to the target site with or without late diastolic potential （LDP） during sinus rhythm in 37 patients and during VT in 2 patients to meet the ablation endpoint： the left posterior fascicuiar block in the surface ECG. Results Thirty-seven patients with ILVT had been treated by RF ablation during sinus rhythm and two had been treated during VT. All of them met the endpoint of the left posterior fascicuiar block. Thirty-eight cases were symptom-free without medications during the follow-up period （range from 3 to 95 months, median 17 months）. One patient developed a clinical recurrence and the left posterior fascicuiar block in surface ECG disappeared. The patient received another treatment. The endpoint was met and the procedure was successful. Conclusions The left posterior fascicuiar block in surface ECG used as an endpoint of RF ablation to treat ILVT is effective. It is important especially in those patients whose VT can not be induced or the inducible condition is unstable. The effective endpoint implied that the left posterior fascicle might be a critical part of the re-entrant circuit.展开更多
文摘A 51-year old male who presented at our hospital for recurrent palpitation for several months was diagnosed dermatomyositis ten years ago and had interstitial lung disease since two years ago. Recently, he was admitted for atypical hepatitis, and received maintenance treatment of oral corticosteroids.
文摘Idiopathic monomorphic ventricular tachycardia and premature ventricular complexes (PVCs) commonly arise from the right and left ventricular outflow tracts (VOT). Their mechanism is most commonly triggered activity from delayed after-depolarizations and successful ablation is performed at the site of earliest endocardial activation. Re-entrant mechanisms have been rarely described. We report a case of an otherwise healthy patient who ultimately underwent six electro-physiology studies (EPS) and suffered numerous implantable cardiac defibrillator (ICD) discharges prior to the successful radiofrequency ablation (RFA) of two idiopathic VOT tachycardias. During the sixth EPS, a proximal aortogram demonstrated a left aortic sinus of valsalva (LASV) aneurysm. Subsequntly, a novel and successful RFA strategy of aneurysm isolation was undertaken. The presence of multiple clinical or inducible VT morphologies and the characterization of a VT as re-entrant should raise concerns that a complex arrhythmogenic substrate is present and defining the anatomy with angiography or an alternative imaging modality is essential in achieving a successful ablation strategy.
基金Supported by the National Natural Science Foundation of China,No.81873484,No.81170167,and No.81270002the Natural Science Foundation of Zhejiang Province,No.LZ16H020001.
文摘BACKGROUND With an increased number of surgical procedures involving the mitral annular region,the risk of mitral valve prolapse(MVP)has also increased.Previous studies have reported that worsening of MVP occurred early after radiofrequency catheter ablation(RFCA)at papillary muscles in ventricular tachycardia(VT)patients with preoperative MVP.CASE SUMMARY We report a case where MVP and papillary muscle rupture occurred 2 wk after RFCA in a papillary muscle originated VT patient without mitral valve regurgitation or prolapse before.The patient then underwent mitral valve replacement with no premature ventricular contraction or VT.During the surgery,a papillary muscle rupture was identified.Pathological examination showed necrosis of the papillary muscle.The patient recovered after mitral valve replacement.CONCLUSION Too many ablation procedures and energy should be avoided.
文摘In patients with structural heart disease, ventricular tachycardia (VT) worsens the clinical condition and may severely affect the shortand long-term prognosis. Several therapeutic options can be considered for the management of this arrhythmia. Among others, catheter ablation, a closed-chest therapy, can prevent arrhythmia recurrences by abolishing the arrhythmogenic substrate. Over the last two decades, different techniques have been developed for an effective approach to both tolerated and untolerated VTs. The clinical outcome of patients undergoing ablation has been evaluated in multiple studies. This editorial gives an overview of the role, methodology, clinical outcome and innovative approaches in catheter ablation of VT.
文摘Background Radiofrequency catheter ablation （RFCA） has been established as an effective and curative therapy for ventricular tachycardia （VT） and severely symptomatic premature ventricular contraction （PVC） from the outflow tract in structurally normal hearts. This study aimed to investigate electrophysiologic characteristics and effects of RFCA for patients with idiopathic VT and symptomatic PVC originating from the valve annulus. Methods Characteristics of body surface electrocardiogram （ECG） and endocardiogram in a successful RFCA target were analyzed in 16 patients with idiopathic VT and symptomatic PVC originating from the valve annulus. Additionally, the ECG characteristics of VT or PVC were compared with those of manifest Wolff-Parkinson-White （WPW） syndrome originating from the same site of origin in 15 patients. Results Thirteen patients were successful, 2 recurrent and 1 failed. The recurrent cases underwent successful ablation the second time guided by the Ensite 3000 mapping system. In all patients with the WPW syndrome, the characteristics of QRS morphology were well matched with those of the VT and PVC that originated from corresponding sites of origin. Conclusions RFCA is an effective curative therapy for VT and There are specific characteristics in ECG and the ablation site accessory pathway＇s algorithm. symptomatic PVC originating from the valve annulus. could be located by means of the WPW syndrome
文摘Electrophysiology study and radiofrequency catheter ablation (RFCA) were performed in 26 patients with refractory sustained ventricular tachycardia (VT). After induction of VT, 12-lead electrocardiogram (ECG) was recorded and QRS morphology and axis of induced VT were studied to identify the origin of VT. The precise site of VT origin were localized by pace mapping and activation mapping carefully. RF energy was delivered through a big-tip deflectable electrode catheter when the earliest site of endocardial activation and a high-frequency and low-amplitude potential of Purkinje fiber, preceding surface QRS by more than 25 ms, were identified and / or a pace map was obtained showing identical QRS complexes in at least 11 of 12 ECG leads. VTs were ablated successfully in 24 of 26 patients (success rate was 92%). For successful ablation, it is essential that the pace map QRS morphology in 12 leads should be identical with that in spontaneous or induced VT as far as possible in performing pace mapping. Pace mapping is safe, simple and has no unfavourable effect on hemodynamics although it takes longer time. Activation mapping takes shorter time and has a high success rate. QRS configuration in spontaneous VT can help to localize the site of VT origin. Deliberate mapping at the site suggested to bo the origin of VT by surface ECG can shorten the duration of mapping and increase the success rate of RFCA. RFCA of VT in patients without structural heart disease is effective, safe, and has a high success rate, so it may be considered as an early therapy for these patients.
文摘Background Verapamil-sensitive, idiopathic left ventricular tachycardia （ILVT） with right bundle branch block configuration and left-axis deviation is known to be due to re-entry mechanism but the exact nature of reentrant circuit in ILVT is not fully elucidated. Radiofrequency （RF） ablation was applied during ventricular tachycardia （VT） and termination of the VT or abolishing the inducibility of the tachycardia was used as an endpoint for successful RF. In this study, the left posterior fascicular block in surface electrocardiogram （ECG） was used as a new endpoint of ablation to cure ILVT. Methods Electrophysiological studies and radiofrequency ablation were performed in 39 consecutive patients [30 men, 9 women; age ranging from 10 to 64 years, mean （29± 16） years] with verapamil-sensitive ILVT and structurally normal hearts. VT could be terminated by the intravenous adininistration of verapamil in all patients. The target site was the midseptum of LV where the earliest Purkinje potentials were recorded during VT. RF current was applied to the target site with or without late diastolic potential （LDP） during sinus rhythm in 37 patients and during VT in 2 patients to meet the ablation endpoint： the left posterior fascicuiar block in the surface ECG. Results Thirty-seven patients with ILVT had been treated by RF ablation during sinus rhythm and two had been treated during VT. All of them met the endpoint of the left posterior fascicuiar block. Thirty-eight cases were symptom-free without medications during the follow-up period （range from 3 to 95 months, median 17 months）. One patient developed a clinical recurrence and the left posterior fascicuiar block in surface ECG disappeared. The patient received another treatment. The endpoint was met and the procedure was successful. Conclusions The left posterior fascicuiar block in surface ECG used as an endpoint of RF ablation to treat ILVT is effective. It is important especially in those patients whose VT can not be induced or the inducible condition is unstable. The effective endpoint implied that the left posterior fascicle might be a critical part of the re-entrant circuit.
