AIMS: We present clinical, electroanatomical mapping (EAM), imaging, and catheter ablation (CA) strategies in patients with myocarditis-related ventricular tachycardia (VT). METHODS AND RESULTS: Between January 2010 and July 2012, 26 consecutive patients underwent imaging-guided CA of myocarditis-related ventricular arrhythmias, 23 of 26 using a combined endo-epicardial approach. Segment per segment correspondence of late enhanced (LE) scar localization with EAM scar was assessed in all patients with available uni/bipolar maps (n = 19). Induced VTs were targeted prior to substrate modification. Late potentials (LPs) abolition constituted a procedural endpoint independently from VT inducibility. Clinical monomorphic VT was induced in 15 of 26 patients (57.7%) and was associated with epicardial LPs in 10 of 15, completely abolished in 7 of 10 patients. Of the 10 patients rendered non-inducible VTs were ablated epicardially in 7. Late potentials were also detected in 7 of 11 initially non-inducible patients and completely abolished in 4. After a median follow-up of 23 (15-31) months, 20 of 26 patients (76.9%) remained free from VT recurrence. Bipolar mapping revealed low-voltage scar (<1.5 mV) in 1 patient endocardially and in 14 of 19 epicardially. Unipolar mapping revealed low-voltage scar (<8 mV) in 12 of 19 patients endocardially and in 18 of 19 epicardially. Correspondence of LE scar localization with endocardial bipolar scar was 1%, with endocardial unipolar scar 23.7%, with epicardial bipolar scar 39.8%, and with epicardial unipolar scar 66.2%. CONCLUSION: Pre-procedural scar imaging and EAM findings support the necessity of an epicardial approach in patients with prior myocarditis. Epicardial unipolar mapping (<8 mV) is superior in scar identification and CA based on substrate modification is safe and effective in this setting. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: We present clinical, electroanatomical mapping (EAM), imaging, and catheter ablation (CA) strategies in patients with myocarditis-related ventricular tachycardia (VT). METHODS AND RESULTS: Between January 2010 and July 2012, 26 consecutive patients underwent imaging-guided CA of myocarditis-related ventricular arrhythmias, 23 of 26 using a combined endo-epicardial approach. Segment per segment correspondence of late enhanced (LE) scar localization with EAM scar was assessed in all patients with available uni/bipolar maps (n = 19). Induced VTs were targeted prior to substrate modification. Late potentials (LPs) abolition constituted a procedural endpoint independently from VT inducibility. Clinical monomorphic VT was induced in 15 of 26 patients (57.7%) and was associated with epicardial LPs in 10 of 15, completely abolished in 7 of 10 patients. Of the 10 patients rendered non-inducible VTs were ablated epicardially in 7. Late potentials were also detected in 7 of 11 initially non-inducible patients and completely abolished in 4. After a median follow-up of 23 (15-31) months, 20 of 26 patients (76.9%) remained free from VT recurrence. Bipolar mapping revealed low-voltage scar (<1.5 mV) in 1 patient endocardially and in 14 of 19 epicardially. Unipolar mapping revealed low-voltage scar (<8 mV) in 12 of 19 patients endocardially and in 18 of 19 epicardially. Correspondence of LE scar localization with endocardial bipolar scar was 1%, with endocardial unipolar scar 23.7%, with epicardial bipolar scar 39.8%, and with epicardial unipolar scar 66.2%. CONCLUSION: Pre-procedural scar imaging and EAM findings support the necessity of an epicardial approach in patients with prior myocarditis. Epicardial unipolar mapping (<8 mV) is superior in scar identification and CA based on substrate modification is safe and effective in this setting. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Marmar Vaseghi; Tiffany Y Hu; Roderick Tung; Pasquale Vergara; David S Frankel; Luigi Di Biase; Usha B Tedrow; Jeffrey A Gornbein; Ricky Yu; Nilesh Mathuria; Shiro Nakahara; Wendy S Tzou; William H Sauer; J David Burkhardt; Venkatakrishna N Tholakanahalli; Timm-Michael Dickfeld; J Peter Weiss; T Jared Bunch; Madhu Reddy; David J Callans; Dhanunjaya R Lakkireddy; Andrea Natale; Francis E Marchlinski; William G Stevenson; Paolo Della Bella; Kalyanam Shivkumar Journal: JACC Clin Electrophysiol Date: 2018-07-25
Authors: E Ene; P Halbfaß; K Nentwich; K Sonne; M Roos; S Fodor; L Lehmkuhl; F Gietzen; S Barth; K Hamm; T Deneke Journal: Herzschrittmacherther Elektrophysiol Date: 2017-05-09
Authors: Fa Po Chung; Chin Yu Lin; Yenn Jiang Lin; Shih Lin Chang; Li Wei Lo; Yu Feng Hu; Ta Chuan Tuan; Tze Fan Chao; Jo Nan Liao; Ting Yung Chang; Shih Ann Chen Journal: Korean Circ J Date: 2018-10 Impact factor: 3.243