Author + information
- Received July 20, 2013
- Revision received September 3, 2013
- Accepted October 7, 2013
- Published online April 15, 2014.
- Yuki Komatsu, MD∗ (, )
- Matthew Daly, MB, CHB,
- Frédéric Sacher, MD,
- Hubert Cochet, MD,
- Arnaud Denis, MD,
- Nicolas Derval, MD,
- Laurence Jesel, MD,
- Stephan Zellerhoff, MD,
- Han S. Lim, MBBS,
- Amir Jadidi, MD,
- Isabelle Nault, MD,
- Ashok Shah, MD,
- Laurent Roten, MD,
- Patrizio Pascale, MD,
- Daniel Scherr, MD,
- Valerie Aurillac-Lavignolle, BSc,
- Mélèze Hocini, MD,
- Michel Haïssaguerre, MD and
- Pierre Jaïs, MD
- Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Institut LYRIC, Equipex MUSIC, Bordeaux, France
- ↵∗Reprint requests and correspondence:
Dr. Yuki Komatsu, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Institute LYRIC, Equipex MUSIC, Avenue de Magellan, Bordeaux 33604, France.
Objectives We evaluated the feasibility and safety of epicardial substrate elimination with endocardial radiofrequency (RF) delivery in patients with scar-related ventricular tachycardia (VT).
Background Epicardial RF delivery is limited by fat or associated with bleeding, extra-cardiac damages, coronary vessels and phrenic nerve injury. Alternative ablation approaches might be desirable.
Methods Forty-six patients (18 ischemic cardiomyopathy [ICM], 13 nonischemic dilated cardiomyopathy [NICM], 15 arrhythmogenic right ventricular cardiomyopathy [ARVC]) with sustained VT underwent combined endo- and epicardial mapping. All patients received endocardial ablation targeting local abnormal ventricular activities in the endocardium (Endo-LAVA) and epicardium (Epi-LAVA), followed by epicardial ablation if needed.
Results From a total of 173 endocardial ablations targeting Epi-LAVA at the facing site, 48 (28%) applications (ICM: 20 of 71 [28%], NICM: 3 of 39 [8%], ARVC: 25 of 63 [40%]) successfully eliminated the Epi-LAVA. Presence of Endo-LAVA, the most delayed and low bipolar amplitude of Epi-LAVA, low unipolar amplitude in the facing endocardium, and Epi-LAVA within a wall thinning area at computed tomography scan were associated with successful ablation. Endocardial ablation could abolish all Epi-LAVA in 4 ICM and 2 ARVC patients, whereas all patients with NICM required epicardial ablation. Endocardial ablation was able to eliminate Epi-LAVA at least partially in 15 (83%) ICM, 2 (13%) NICM, and 11 (73%) ARVC patients, contributing to a potential reduction in epicardial RF applications. Pericardial bleeding occurred in 4 patients with epicardial ablation.
Conclusions Elimination of Epi-LAVA with endocardial RF delivery is feasible and might be used first to reduce the risk of epicardial ablation.
This research was supported by Leducq Foundation grant number: 09 CVD 03. Dr. Derval has received consulting fees from St. Jude Medical. Dr. Nault has served on the Speaker's Bureau for Biosense Webster, Medtronic, Bayer Healthcare, and Boehringer Ingelheim. Drs. Hocini, Haïssaguerre, and Jaïs have received fees for presentations at meetings from Biosense Webster and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 20, 2013.
- Revision received September 3, 2013.
- Accepted October 7, 2013.
- American College of Cardiology Foundation