Journal of cardiovascular electrophysiology
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J. Cardiovasc. Electrophysiol. · Jul 2009
Randomized Controlled TrialEsophageal damage during radiofrequency ablation of atrial fibrillation: impact of energy settings, lesion sets, and esophageal visualization.
Atrioesophageal fistula is an uncommon but often lethal complication of atrial fibrillation (AF) ablation. The purpose of our study was to prospectively investigate the incidence of esophageal ulcerations (ESUL) as well as the impact of energy settings, radiofrequency lesion sets, and direct visualization of the esophagus on esophageal wall injury. ⋯ ESUL is a rare finding when using a reasonable energy maximum of 25 W with open-irrigated tip catheters at the posterior wall. Lower energy settings may increase safety without losing efficacy. Additional linear radiofrequency lesions increase the risk of ESUL development.
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J. Cardiovasc. Electrophysiol. · Jul 2009
Case ReportsTachycardia-induced right ventricular cardiomyopathy: epicardial radiofrequency ablation of an unusual and unexpected ventricular tachycardia.
A 38-year-old man without prior medical history was hospitalized for sustained monomorphic ventricular tachycardia (VT) left bundle branch block pattern with inferior QRS axis resistant to beta blockers. Right ventricular (RV) ejection fraction (EF) was 28%. Left ventricular EF was normal. ⋯ Percutaneous epicardial radiofrequency application at the lateral mitral annulus was successful. The RVEF later normalized. Some VTs originating from the left ventricular epicardium are potential mimickers of benign VTs originating from the ventricular outflow tract (right or left) or arrhythmogenic right ventricular cardiomyopathy VT and they may induce isolated RV dysfunction.
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J. Cardiovasc. Electrophysiol. · Jun 2009
ReviewStrategies for epicardial mapping and ablation of ventricular tachycardia.
Catheter ablation for ventricular tachycardia (VT) is becoming an essential component of the successful management of patients with structural heart disease and refractory ventricular arrhythmias. Despite detailed mapping and ablation from the endocardium, nearly a third of VT circuits remain inaccessible. ⋯ Potential risks include risk of injury to an epicardial coronary artery, the phrenic nerve, subdiaphragmatic vessels, and right ventricle. We describe the indications for and approach to catheter ablation of VT for the pericardial space.
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J. Cardiovasc. Electrophysiol. · Jun 2009
Clinical TrialClinical application of PET/CT fusion imaging for three-dimensional myocardial scar and left ventricular anatomy during ventricular tachycardia ablation.
Integration of 3D PET with Voltage Map for VT Ablation. Background: Image integration has the potential to display three-dimensional (3D) scar anatomy and facilitate substrate characterization for ventricular tachycardia (VT) ablation. However, the current generation of clinical mapping systems cannot display 3D left ventricle (LV) anatomy with embedded 3D scar reconstructions or allow display of border zone and high-resolution anatomic scar features. ⋯ Real-time display of registered high-resolution CT images allowed the simultaneous characterization of scar-related anatomic changes. Conclusion: Integration of PET/CT reconstruction allows simultaneous 3D display of myocardial scar and border zone embedded into the LV anatomy as well as the display of detailed scar anatomy. Multimodality imaging may enable a new image-guided approach to substrate-guided VT ablation.
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J. Cardiovasc. Electrophysiol. · May 2009
ReviewThe work-up and management of patients with apparent or subclinical cardiac sarcoidosis: with emphasis on the associated heart rhythm abnormalities.
In patients with newly diagnosed AV block and/or ventricular tachycardia, cardiac sarcoidosis should always be considered in the differential diagnosis. In addition to the pacemaker implant, cardiac resynchronization therapy (CRT) should be selected for severe heart failure patients who have class III or IV heart failure, LVEF