ABSTRACTS
Abstracts of the scientific meeting of the Netherlands Society of Cardiology (NWC) 24-26 October 2002, De Heerlickheijd, Ermelo PARALLEL SESSION I - Electrophyslology/treatment rhythm disorders
Chairmen: Prof Dr. M.J. Schalij, Dr. T.A. Simmers Radlofrequency catheter ablation of ventricular tachycardla guided by Intracardiac echocardlography; Initlal experience
MRM Jongbloed, JJ Bax, AE Borger van der Burg, NMS de Groot, K Zeppenfeld, M Bootsma, EE van der Wall, MJ Schalij. Leiden University Medical Center, the Netherlands.
Background. Scar tissue and aneurysmatic dilatation ofthe ventncular myocardium are associated with ventricular tachycardia (VT). Radiofrequency catheter ablation (RFCA) is the treatment of choice in selected patients with drug-refractory, hemodynamic stable VT. However, RFCA in VTpatients is associated with an increased risk ofprocedure related complications. We hypothesized that identification ofareas with a/dyskinesia or aneurysm and early monitoring of complications with intracardiac echocardiography (ICE) has beneficial effects on both procedure time and outcome. Purpose. To assess the feasibility of ICE to guide RFCA of VT and monitor complications, such as perforation. Methods. Twelve patients with a history ofischemic heart disease were treated with RFCA guided by ICE. A multifrequency (5-10 MHz) phased array ultrasound transducer was introduced in the right ventricle (RV) via a transfemoral approach. Results. Left ventricular (LV) anatomy could be visualized with the ultrasound catheter positioned in the RV. In all patients, an aneurysm ofthe LVwas identified (7 anterior/apical, 5 inferior). Mapping in sinus rhythm showed fragmented signals at the border of the aneurysms. During VT, signals were earliest in this area and RFCA was performed guided by ICE. Mean procedure time was 222 min (range 205-235) and mean fluoroscopy time 32 min (range 22-38). After RFCA, noVT could be induced. No complications occurred. Condusion. ICE is feasible in guiding catheters and monitor catheter tip-endocardial contact and the occurrence of procedure related complications during RFCA of VT. Larger patient series have to be studied to assess the effect on outcome. Radlofrequency ablation of post-infarction ventricular tachyarrhythmias during cardiac surgery. First experience
R Kaplan, TH Sie, WP Beukema, JCA Hoomtje, AR Ramdat Misier. Isala Klinieken, location Weezenlanden, Zwolle, the Netherlands.
Background. In selected patients surgical treatment for late myocardial infarction (MI) related ventricular tachyarrhythmias (TA), offers arrhythmia abolition and an opportunity for coronary artery bypass grafting (CABG) and ventricular remodeling. Radiofrequency (RF) catheter ablation has become the treatmnent of choice for most supraventricular tachycardias and some types of ventricular tachycardias (VT). Methods and Results. Between June 1997 and August 2000, 11 patients (10 male) with mean age 69±0.2 years (54-81) with sustained ventricular TAlate after MI underwent anti-arrhythmic surgery. Ten patients had 3 vessel disease (VD), one patient had 1 VD. Seven patientsts had a sustained VT and 4 patients had ventricular fibrillation (VF) on hospital admission. All the patients had a MI 4±0.9 yr (0- 17 years) prior to the index arrhythmia. The mean ejection fraction wvas 29±0.5%. Preoperative PES revealed: sustained VT (8 patients), VF (2 patients) and non-inducebility in 1 patient. In all the patients endocardial RF energy was used to created linear lesions that connected the dense scar area to the normal endocardium. The placement oflinear lesions was visual guided. Additional procedures were aneurysmectomy (7 patients) and CABG ( 11 patients). PES after surgery showed non-inducebility for VT/VF in all patients. There was no in-hospital mortality. After follow-up of25±0.2 months (9-52) 4 patients died (non-cardiac cause 3 and 1 unexplained sudden death). There were no hospital admissions for heart failure nor arrhythmia. None were on anti-arrhythmic drugs.
2
Condusion. Intraoperative endocardial RF ablation can be considered as an alternative to eliminate postinfarction ventricular TA, without intraoperative mapping, in selected patients. C en A Trial: a prospective, randomised study comparing transvenous cryo energy and radlofrequency ablation In atrioventricular nodal reentrant tachycardia and (para)septal pathways. Preliminary data
GP Kimman, T Szili-Torok, MF Scholten, J Res, DAMJ Theuns, LJ Jordaens. Department of clinical electrophysiology, Erasmus Medical Centre, Rotterdam, the Netherlands.
Background. Radiofrequency (RF) energy has become the preferred modality for transvenous catheter ablation of tachyarrhythmias, and has proven to be highly effective, and relatively safe. In most studies on atrioventricular nodal reentrant tachycardia (AVNRT), a 1-3% incidence of complete heart block is mentioned, even when the slow pathway was the target. Cryothermal energy has the ability to create reversible lesions, thereby demonstrating the potential success of prospective ablation sites without inducing permanent injury. Furthermore, cryolesions have sharp, well-demarcated margins. Therefore, cryothermal energy theoretically decreases the risk for complete heart block, and is less thrombogenic and proarrythmic. Some additional shortcomings and advantages of both energy forms have to be studied. This trial will address both AVNRT and (para)septal pathways, which run in close proximity to the compact AV node. This abstract only deals with the outcome of patients suffering from recurrent AVNRT. Methods. In this, prospective, randomised trial, until now 43 patients were included. After a diagnostic EP study, AVNRT remained the diagnosis in 29 patients. RF ablation was performed in 16 patients, and compared with 11 patients treated with cryoablation. In both groups a 3D navigation system (LocaLisa) was used. Results. Acute success was achieved in 15 patients (94%) in the RF group versus 10 (91%) in the cryo group. The number of applications in successfitlly treated patients was 8.2 (1-21) in the RF, and 1.8 (1-3) in the cryo group (p
Abstracts of the scientific meeting of the Netherlands Society of Cardiology (NWC) 24-26 October 2002, De Heerlickheijd, Ermelo PARALLEL SESSION I - Electrophyslology/treatment rhythm disorders
Chairmen: Prof Dr. M.J. Schalij, Dr. T.A. Simmers Radlofrequency catheter ablation of ventricular tachycardla guided by Intracardiac echocardlography; Initlal experience
MRM Jongbloed, JJ Bax, AE Borger van der Burg, NMS de Groot, K Zeppenfeld, M Bootsma, EE van der Wall, MJ Schalij. Leiden University Medical Center, the Netherlands.
Background. Scar tissue and aneurysmatic dilatation ofthe ventncular myocardium are associated with ventricular tachycardia (VT). Radiofrequency catheter ablation (RFCA) is the treatment of choice in selected patients with drug-refractory, hemodynamic stable VT. However, RFCA in VTpatients is associated with an increased risk ofprocedure related complications. We hypothesized that identification ofareas with a/dyskinesia or aneurysm and early monitoring of complications with intracardiac echocardiography (ICE) has beneficial effects on both procedure time and outcome. Purpose. To assess the feasibility of ICE to guide RFCA of VT and monitor complications, such as perforation. Methods. Twelve patients with a history ofischemic heart disease were treated with RFCA guided by ICE. A multifrequency (5-10 MHz) phased array ultrasound transducer was introduced in the right ventricle (RV) via a transfemoral approach. Results. Left ventricular (LV) anatomy could be visualized with the ultrasound catheter positioned in the RV. In all patients, an aneurysm ofthe LVwas identified (7 anterior/apical, 5 inferior). Mapping in sinus rhythm showed fragmented signals at the border of the aneurysms. During VT, signals were earliest in this area and RFCA was performed guided by ICE. Mean procedure time was 222 min (range 205-235) and mean fluoroscopy time 32 min (range 22-38). After RFCA, noVT could be induced. No complications occurred. Condusion. ICE is feasible in guiding catheters and monitor catheter tip-endocardial contact and the occurrence of procedure related complications during RFCA of VT. Larger patient series have to be studied to assess the effect on outcome. Radlofrequency ablation of post-infarction ventricular tachyarrhythmias during cardiac surgery. First experience
R Kaplan, TH Sie, WP Beukema, JCA Hoomtje, AR Ramdat Misier. Isala Klinieken, location Weezenlanden, Zwolle, the Netherlands.
Background. In selected patients surgical treatment for late myocardial infarction (MI) related ventricular tachyarrhythmias (TA), offers arrhythmia abolition and an opportunity for coronary artery bypass grafting (CABG) and ventricular remodeling. Radiofrequency (RF) catheter ablation has become the treatmnent of choice for most supraventricular tachycardias and some types of ventricular tachycardias (VT). Methods and Results. Between June 1997 and August 2000, 11 patients (10 male) with mean age 69±0.2 years (54-81) with sustained ventricular TAlate after MI underwent anti-arrhythmic surgery. Ten patients had 3 vessel disease (VD), one patient had 1 VD. Seven patientsts had a sustained VT and 4 patients had ventricular fibrillation (VF) on hospital admission. All the patients had a MI 4±0.9 yr (0- 17 years) prior to the index arrhythmia. The mean ejection fraction wvas 29±0.5%. Preoperative PES revealed: sustained VT (8 patients), VF (2 patients) and non-inducebility in 1 patient. In all the patients endocardial RF energy was used to created linear lesions that connected the dense scar area to the normal endocardium. The placement oflinear lesions was visual guided. Additional procedures were aneurysmectomy (7 patients) and CABG ( 11 patients). PES after surgery showed non-inducebility for VT/VF in all patients. There was no in-hospital mortality. After follow-up of25±0.2 months (9-52) 4 patients died (non-cardiac cause 3 and 1 unexplained sudden death). There were no hospital admissions for heart failure nor arrhythmia. None were on anti-arrhythmic drugs.
2
Condusion. Intraoperative endocardial RF ablation can be considered as an alternative to eliminate postinfarction ventricular TA, without intraoperative mapping, in selected patients. C en A Trial: a prospective, randomised study comparing transvenous cryo energy and radlofrequency ablation In atrioventricular nodal reentrant tachycardia and (para)septal pathways. Preliminary data
GP Kimman, T Szili-Torok, MF Scholten, J Res, DAMJ Theuns, LJ Jordaens. Department of clinical electrophysiology, Erasmus Medical Centre, Rotterdam, the Netherlands.
Background. Radiofrequency (RF) energy has become the preferred modality for transvenous catheter ablation of tachyarrhythmias, and has proven to be highly effective, and relatively safe. In most studies on atrioventricular nodal reentrant tachycardia (AVNRT), a 1-3% incidence of complete heart block is mentioned, even when the slow pathway was the target. Cryothermal energy has the ability to create reversible lesions, thereby demonstrating the potential success of prospective ablation sites without inducing permanent injury. Furthermore, cryolesions have sharp, well-demarcated margins. Therefore, cryothermal energy theoretically decreases the risk for complete heart block, and is less thrombogenic and proarrythmic. Some additional shortcomings and advantages of both energy forms have to be studied. This trial will address both AVNRT and (para)septal pathways, which run in close proximity to the compact AV node. This abstract only deals with the outcome of patients suffering from recurrent AVNRT. Methods. In this, prospective, randomised trial, until now 43 patients were included. After a diagnostic EP study, AVNRT remained the diagnosis in 29 patients. RF ablation was performed in 16 patients, and compared with 11 patients treated with cryoablation. In both groups a 3D navigation system (LocaLisa) was used. Results. Acute success was achieved in 15 patients (94%) in the RF group versus 10 (91%) in the cryo group. The number of applications in successfitlly treated patients was 8.2 (1-21) in the RF, and 1.8 (1-3) in the cryo group (p
