We describe a pericardioesophageal defect resulting from thermal injury during epicardial left ventricular tachycardia ablation in a 69-year-old man who failed 2 endoepicardial ablation attempts. Ventricular tachycardia was localized to the scar (Figure 1A). Unipolar radiofrequency ablation (Smart Touch, Thermocool catheter [Biosense Webster, Diamond Bar, California]) from the endocardium, epicardium, and coronary sinus failed and bipolar radiofrequency (epi-endocardium) was needed to render the ventricular tachycardia noninducible. The patient was discharged home on rivaroxaban but presented 3 days later with cardiac tamponade requiring drainage. The patient was initiated on oral colchicine and anticoagulation was discontinued. One month later, the patient presented with hematemesis and a mass located at 30 cm from the incisors was seen on endoscopy (Figure 1B). Before further investigation or treatment, the patient developed massive hematemesis and expired. At postmortem, a gastric ulcer ...
An aspect of various embodiments of the present invention system and method provide, but not limited thereto, a novel means for epicardial ablation using a double-curve steerable sheath and a double-curve deflectable open irrigated-tip/suction catheter that can be guided around the apex of the heart and adjusted so as to position the distal tip optimally. The catheter can also both deliver fluid to and withdraw fluid from the pericardial space. Access to the epicardial surface of the heart is via a subxiphoid entry. The method and means presented include, but are not limited to, steering, energy delivery, bipolar mapping, placement and use of electrodes, irrigation, suction of irrigation fluid, and other details of the subject invention.
The CHANNEL™ Steerable Sheath from Boston Scientific is designed for precision device placement in ablation cases offering versatility, dependability and consistency.
Idiopathic ventricular tachycardia (VT) has been described from the epicardial surface of the left ventricle (LV), usually near the summit of the LV in the outflow tract. Ablation of these VTs may be possible by delivery of energy within the coronary venous system or directly on the epicardial surface. We describe a distinct syndrome of focal epicardial VT induced by catecholamine infusion that arises from the crux of the heart. Among 340 cases of idiopathic VT referred for catheter ablation, 4 patients were identified with a clinical syndrome of catecholamine sensitive VT that was mapped to the epicardial surface at the crux of the heart. There were 3 males and 1 female (age 31-79 yrs, mean 58). VT was sustained in all patients and associated with syncope or near syncope in 3 of 4 pts. The LVEF was ,0.55 in 3 pts and mildly depressed (0.45) in 1 pt. In all pts VT could be induced with programmed stimulation or burst pacing from the right ventricular apex but required the infusion of ...
BACKGROUND: Ischemic ventricular fibrillation in experimental models has been shown to progress through a series of stages. Progression of ischemic VF in the in vivo human heart has not been determined. METHODS AND RESULTS: We studied 10 patients undergoing cardiac surgery. Ventricular fibrillation was induced by burst pacing. After 30 seconds, global myocardial ischemia was induced by aortic cross-clamp and maintained for 2.5 minutes, followed by coronary reflow. Epicardial activity was sampled (1 kHz) with a sock that contained 256 unipolar contact electrodes. Dominant frequencies were calculated with a fast Fourier transform with a moving window. The locations of phase singularities and activation wavefronts were identified at 10-ms intervals. Preischemic (perfused) ventricular fibrillation was maintained by a disorganized mix of large and small wavefronts. During global myocardial ischemia, mean dominant frequencies decreased from 6.4 to 4.7 Hz at a rate of -0.011±0.002 Hz s(-1) (P|0.001) and then
Introduction: Endocardial catheter ablation for ventricular arrhythmias (VA) and electrical storm (ES) in patients with ischemic cardiomyopathy has shown moderate long term results. The reported need for epicardial ablation in these patients is around 12%. We investigated the impact of epicardial elimination of all abnormal potentials (AP) within the scar to increase the long-term ablation success rate.. Methods: Fifty-three consecutive patients with ischemic cardiomyopathy and VAs and or ES undergoing VAs ablation at our Institution were enrolled in this study. Epicardial access was obtained in all patients before ablation. All patients underwent endocardial and epicardial mapping and ablation of all AP within the scar in sinus rhythm.. Results: Before ablation, the clinical VT was inducible endocardially in 81% of the cases (43pts). Interestingly in 9% of the cases (5 patients), the clinical VT could be induced only from the epicardial scar containing APs and was not inducible in the remaining ...
BACKGROUND: The mechanisms that sustain ventricular fibrillation (VF) in the human heart remain unclear. Experimental models have demonstrated either a periodic source (mother rotor) or multiple wavelets as the mechanism underlying VF. The aim of this study was to map electrical activity from the entire ventricular epicardium of human hearts to establish the relative roles of these mechanisms in sustaining early human VF. METHODS AND RESULTS: In 10 patients undergoing cardiac surgery, VF was induced by burst pacing, and 20 to 40 seconds of epicardial activity was sampled (1 kHz) with a sock containing 256 unipolar contact electrodes connected to a UnEmap system. Signals were interpolated from the electrode sites to a fine regular grid (100x100 points), and dominant frequencies (DFs) were calculated with a fast Fourier transform with a moving 4096-ms window (10-ms increments). Epicardial phase was calculated at each grid point with the Hilbert transform, and phase singularities and activation wavefronts
Simulation-driven engineering has put rockets in space, airplanes in the sky, and self-driving cars on the road. Computational approaches have also contributed to advancements in clinical medicine and human health.1-3 In the arena of cardiac care, the recent emphasis on personalized medicine has provided a significant impetus for the development of predictive approaches combining imaging and computational modeling that can be applied to the diagnosis and treatment of heart rhythm disorders. A major advance in this direction is the creation and translation into clinical practice of novel imaging- and simulation-based strategies for predicting an individuals risk of sudden cardiac death (SCD) and for the noninvasive planning of optimal personalized antiarrhythmia therapies. Clinical decisions about the stratification of patients for SCD risk resulting from arrhythmia and for determining the optimal targets for antiarrhythmia ablation therapies could greatly benefit from such targeted developments ...
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This study found no differences in the overall prevalence of LVSD between white and non-white patients, the majority being South Asian in this study. However, we did find significant differences in the underlying aetiology of LVSD, finding a higher proportion of underlying CAD in non-white patients. Thus, although there was a higher prevalence of ischaemic cardiomyopathy in non-white patients than in white patients (3.4% v 2.0%, respectively, for LVEF , 45%; and 3.8% v 2.8%, respectively, for LVEF , 50%), there was no overall excess of LVSD in non-white patients due to fewer cases of non-ischaemic cardiomyopathy.. Potential risk factors for CAD and thus ischaemic cardiomyopathy in South Asians include a lower concentration of high density lipoprotein cholesterol and higher prevalence of diabetes mellitus as seen in this and other studies.14 Other potential factors are genetic factors, with a greater tendency to central obesity in South Asian children compared with white children,24 and a higher ...
BENEDICT M. GLOVER, EUGENE DOWNAR, IMAD HAMEEDULLAH, ANDREW CREAN and VIJAY S. CHAUHAN Dual Epicardial Ventricular Tachycardia: A Tale of Two VTs Pacing and Clinical Electrophysiology 35. Version of Record online: 18 AUG 2010 , DOI: 10.1111/j.1540-8159.2010.02856.x. Complete the form below and we will send an e-mail message containing a link to the selected article on your behalf. Required = Required Field. ...
In this issue of iJACC, Esposito et al. (11) report on a study of 42 patients referred for VT ablation evaluated with DE-CT prior to electro-anatomic mapping. The majority of patients presented with implantable cardioverter-defibrillators. Metal streak artifacts affected ,2% of the left ventricle and 10% of segments could not be assessed due to poor imaging quality. Thirty-nine patients had CT evidence of scar with 36 patients demonstrating DE affecting 4.6 myocardial segments. The investigators found a moderate correlation between scar size detected by DE-CT and bipolar electro-anatomic mapping (κ = 0.536); 79% and 81% of late potentials and ablation sites were located within CT scar segments, respectively. A point-by-point analysis of 16 patients demonstrated that 70% and 84% of low bipolar voltage points were within the DE-CT defined scar plus a 5 or 10 mm surrounding area. These findings are in accordance with previous reports using nondelayed enhancement features of cardiac CT for scar ...
TY - CHAP. T1 - Molecular and Cellular Basis of Cardiac Electrophysiology. AU - Tomaselli, Gordon. AU - Roden, Dan M.. PY - 2005/12/1. Y1 - 2005/12/1. UR - http://www.scopus.com/inward/record.url?scp=84882901009&partnerID=8YFLogxK. UR - http://www.scopus.com/inward/citedby.url?scp=84882901009&partnerID=8YFLogxK. U2 - 10.1016/B978-0-443-06570-5.50007-1. DO - 10.1016/B978-0-443-06570-5.50007-1. M3 - Chapter. AN - SCOPUS:84882901009. SN - 9780443065705. SP - 11. EP - 311. BT - Electrophysiological Disorders of the Heart. PB - Elsevier Inc.. ER - ...
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This paper details the dissection procedure, instrumental setup, and experimental conditions during optical mapping of transmembrane...
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This meta-analysis is limited by the studies included in the analysis. All of the studies were observational studies, and therefore they are susceptible to selection bias. There were significant differences in the patients included and the strategy used when performing VT ablations. Although the overall strategy was to target all inducible VTs, only 1 study indicated ablation of all clinically relevant VTs as a predetermined end point.23 Table II in the Data Supplement indicates the specific protocols and catheters used in the analyzed studies.. Another important limitation is the definition of the clinical VT. The definition used in the selected studies is not uniform and is not based on the 12-lead ECG in all studies. Because 12-lead ECGs are not available for all patients, VT electrogram morphology from implantable cardioverter defibrillators can be used instead with similar accuracy and have been found to be helpful in identifying the clinical VT.5 This definition was used by only one, but ...
This analysis confirms that noninducibility of any VT after catheter ablation for patients with prior MI is significantly associated with a decreased risk of the primary outcome of a composite endpoint of death, appropriate shock, or VT storm after 30 days in addition to the secondary outcome of a composite of appropriate ICD shock at any time, VT storm at any time, and sustained VT below the ICD detection limit. Although the VANISH design allowed a procedural endpoint if only VT ,300 ms was inducible, our analysis suggests that even these faster VTs may predict worse outcomes. These results are particularly important given that the VANISH trial was a randomized controlled trial with standardized ICD programming and AAD use.. Although we clearly found that patients rendered noninducible with VT ablation had a better prognosis, we were unable to identify any baseline clinical characteristics that were predictive of noninducibility in this patient population. Other studies have demonstrated the ...
A right ventricular (RV) myocardial infarction (MI) may yield precordial ST-segment elevation (STE). Accordingly, combined inferior and precordial STE may be produced during an inferior-RV MI. Such an electrocardiographic picture may be mistakenly regarded as showing wrapped left anterior descending artery (LADA) occlusion or double vessel occlusion. We present a patient with inferior-RV MI and STE in the inferior, all precordial and right chest leads, in whom the diffuse precordial STE was probably mistakenly regarded as showing anterior MI. However, the STE resolution in V1-V2 and late R wave in V1, which were combined with a recanalized RV branch, favored the RV origin of this STE. Furthermore, the LADA was patent when V3-V6 showed severe ischemia, while its lesion was angiographically stable. Thus its simultaneous occlusion was unlikely. The late R wave in V1 indicates RV transmural conduction delay;as highlighted herein, it is diagnostic of a RV myocardial infarction. (Cardiol J 2010; 17, ...
A suction assisted ablation device having a support surface, suction elements disposed adjacent the support surface, at least one electrode and at least one suction conduit is provided. The device may further include fluid openings, which allow fluid to irrigate target tissue and aid in ablation. A method for ablating tissue using suction is also provided.
The concept of mapping rhythmic activation of the heart dates back to the beginning of last century, with initial descriptions of reentry in turtle hearts1, to the first systematic mapping of sinus rhythm and then atrial flutter by Lewis et al2. Barker et al3 were the first to map the human heart. Initial mapping was primarily performed using single probes to record activation in different regions of the heart. The 1960s and 70s saw the development of computerized mapping of the human heart, e.g. in the cure of Wolf-Parkinson-White syndrome as well as in the study of Langendorff preparations4. In fact, most of the recent advances in cardiac mapping have focused on improvements in multisite recordings within the heart, with the ability to simultaneous record electrical activation from several hundreds of sites having contributed significantly to our understanding of atrial and ventricular arrhythmias. Despite these recent advances, multisite contact mapping suffers from several limitations, ...
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Any changes that occur within a cardiac electrophysiology facility during the three-year accreditation cycle must be reported to the IAC.
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We offer a wide range of systems and components for extracellular recordings in vitro on various types of preparations. Find here a few of the most important examples of cardiac application studies with the MEA-System.. Lonza white paper: Cryopreserved Neonatal Rat Ventricular Cardiomyocytes in Long-term Culture Display Normal Morphology and Functional Activity. Application notes for using Cardiomyocytes with the Multi Channel MEA-Systems:. ...
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Probl m je, e on u ty dolary nikdo necht l, o dolar byl z jem proto e byl do roku 1971 kryt zlatem a kdykoliv bylo mo n jej sm nit za zlato, sv t ho proto pou val jako rezervn m nu. Nicm n t m jak USA, pota mo FED tiskl dolary jak smysl zbaven museli toto zru it, ale povedl se jim jin kousek, p esm d ili Saudy aby ropu obchodovali v hradn za dolary. Tim se misto rovn tka $=zlato objevilo rovn tko $=ropa. Ale sv te divse ouplnou n hodou jist Sad m cht l zm nu a prosaz val jako hlavn m nu pro obchody s ropou Euro, jaja jaj to USA nemohli dovolit, a d l to ji zn te ...
A method for treating the heart and associated vessels and tissues, by controlling the temperature of the pericardial space and/or introducing therapeutic agents, drugs or the like thereto, includes providing a fluid, liquid(s), gas(es) or mixtures thereof, with or without therapeutic agents, drugs or the like, and heating and/or cooling, this fluid. At a time proximate to the heating and/or cooling of the fluid, the pericardial space is accessed by pericardiocentesis, such that the pericardium is punctured and the pericardial space is instrumentized at a location, and in particular, a location where treatment is desired. The heated and/or cooled fluid is then delivered to the pericardial space. At a time after delivery, the fluid is withdrawn from the pericardium, through either the same catheter, or through another catheter at different point along the pericardium, that was also instrumentized (catheterized) by standard pericardiocentesis procedures. This delivery and withdrawal of the fluid may be
The Impella 2.5 is a percutaneous heart pump that will be used to provide partial circulatory support -. The Impella 2.5 is approved by the US Food and Drug Administration and is being tested to see if it helps keep the patients blood pressure stable during the cardiac ablation procedure. The Impella 2.5 Circulatory Support System works by placing a small pump into the left pumping chamber of the heart which will then help the heart circulate blood throughout the body. The Impella 2.5 Circulatory Support system will be removed once the heart no longer needs help with the pumping action which can be at any time from just after the completion of the heart procedure up to several days post procedure as determined by physician ...
Atrial focal activity has been demonstrated by high-density epicardial mapping (11-13), but to date this has not been feasible by endocardial mapping with conventional catheters. Using a novel multispine mapping catheter applied to the atrial endocardium, we have been able to map both the direction of wave front propagation and the site of earliest local atrial activation during AF. A centrifugal activation pattern is described by activation spreading from center to periphery in all five spines of this mapping catheter, excluding any entry of wave fronts from outside the mapping area; under such circumstances, the center of the mapping area most likely represents a focal source of activity. This has been confirmed in patients with focal atrial tachycardia where sites demonstrating an identical pattern of centrifugal activation were successful targets for catheter ablation (15). Although a centrifugal activation pattern may reflect endocardial breakthrough from the epicardium (for example, if ...
We present a case of Great Cardiac Vein cryoablation in order to suppress idiopathic epicardial Ventricular Tachycardia after failed Radiofrequency ablation via the epicardium and GCV.
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Cardiac Electrophysiology describes the electrical activity and functionality of the heart. This study guide provides a clinical overview of the basics.
This book reflects how the concern regarding the effects of radiation exposure in patients and health personnel involved in cardiac electrophysiology (EP) has inspired new developments in cardiac elec