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Hein J. J. Wellens - One of the best experts on this subject based on the ideXlab platform.
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radiofrequency catheter ablation of Idiopathic Ventricular Tachycardia originating in the main stem of the pulmonary artery
Journal of Cardiovascular Electrophysiology, 2002Co-Authors: Carl Timmermans, Luz-maria Rodriguez, Argelia Medeiros, Harry J.g.m. Crijns, Hein J. J. WellensAbstract:Idiopathic Pulmonary Artery Ventricular Tachycardia. We report the case of a patient in whom successful radiofrequency catheter ablation of an Idiopathic Ventricular Tachycardia (VT) originating in the main stem of the pulmonary artery was performed. After successful ablation of the index arrhythmia, which was an Idiopathic right Ventricular outflow tract VT, a second VT with a different QRS morphology was reproducibly induced. Mapping of the second VT revealed the presence of myocardium approximately 2 cm above the pulmonary valve. Application of radiofrequency energy at this site resulted in termination and noninducibility of this VT. After 6-month follow-up, the patient remained free from VT recurrences.
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Radiofrequency catheter ablation of Idiopathic Ventricular Tachycardia originating in the main stem of the pulmonary artery.
Journal of cardiovascular electrophysiology, 2002Co-Authors: Carl Timmermans, Luz-maria Rodriguez, Argelia Medeiros, Harry J.g.m. Crijns, Hein J. J. WellensAbstract:We report the case of a patient in whom successful radiofrequency catheter ablation of an Idiopathic Ventricular Tachycardia (VT) originating in the main stem of the pulmonary artery was performed. After successful ablation of the index arrhythmia, which was an Idiopathic right Ventricular outflow tract VT, a second VT with a different QRS morphology was reproducibly induced. Mapping of the second VT revealed the presence of myocardium approximately 2 cm above the pulmonary valve. Application of radiofrequency energy at this site resulted in termination and noninducibility of this VT. After 6-month follow-up, the patient remained free from VT recurrences.
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predictors for successful ablation of right and left sided Idiopathic Ventricular Tachycardia
American Journal of Cardiology, 1997Co-Authors: Luz-maria Rodriguez, Carl Timmermans, Joep L.r.m. Smeets, Hein J. J. WellensAbstract:Abstract This study reports on predictors for successful radiofrequency (RF) ablation of Idiopathic Ventricular Tachycardia (VT) in 48 patients—35 with right Ventricular (RV) outflow tract and 13 with left Ventricular VT. In RV outflow tract Idiopathic VT, RF ablation was successful in 29 of 35 patients (83%). The following information allowed differentiation between patients with and without a successful RF ablation: >1 induced VT morphology (0 vs 3); presence of delta wave-like beginning of the QRS (2 vs 3) and ≥11 of 12 leads showing a “match” between the clinical VT and the pacemap (28 vs 1). Endocardial activation times were not different between both groups (−15 ± 18 vs −4 ± 5 ms). In left ventricle Idiopathic VT, RF ablation was successful in 12 of 13 patients (92%). In patients who underwent successful ablation, 1 VT morphology was induced and no delta wave-like beginning of the QRS was present; a correlation between clinical VT and the pacemap ≥11 of 12 leads was found and the endocardial activation time preceded the QRS (range of −5 to −58 ms [mean −30 ± 14]). Purkinje activity was observed in 5 of 7 patients with an Idiopathic VT originating from the inferoposterior region but not from the inferoapical region of the left ventricle. Four patients (14%) with RV outflow tract Idiopathic VT had recurrence during a mean follow-up of 2 to 50 months (mean 30 ± 12). Thus, (1) in RV outflow tract Idiopathic VT a good pacemap was more important than an early endocardial activation time; (2) an optimal pacemap as well as an early endocardial activation time were important predictors for successful ablation of the left ventricle Idiopathic VT; (3) Purkinje activity was recorded in VTs arising in the inferoposterior region of the left ventricle; and (4) factors for unsuccessful ablation for Idiopathic VT were >1 induced VT morphology, a delta wave-like beginning of the QRS, and a VT/pacemap correlation
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Radiofrequency catheter ablation of Idiopathic Ventricular Tachycardia originating in the anterior fascicle of the left bundle branch.
Journal of cardiovascular electrophysiology, 1996Co-Authors: Luz-maria Rodriguez, Carl Timmermans, Joep L.r.m. Smeets, Hans J. Trappe, Hein J. J. WellensAbstract:Ablation of an Anterior Fascicular Idiopathic VT. Introduction: Idiopathic Ventricular Tachycardia (VT) originating in or close to the anterior fascicle of the left bundle is rare. A patient with no structural heart disease and VT with a right bundle branch block configuration and right-axis deviation underwent an electrophysiologic examination. Methods and Results: Both endocardial activation mapping during VT and pacemapping were performed via a transseptal approach to localize the site of origin of the VT. Endocardial recordings of the His bundle and the posterior and anterior fascicles of the left bundle branch revealed an origin of the VT in or close to the anterior fascicle. The Purkinje potential at that site preceded the QRS complex by 20 msec, with pacemapping showing an optimal match between the paced rhythm and the clinical VT. RF energy delivered at this site terminated the VT. A left anterior nemiblock appeared after RF ablation. Ten months later, the patient is free from recurrences of VT. Conclusions: Idiopathic VT originating in or close to the anterior fascicle was cured by RF ablation. A Purkinje potential preceding the QRS during Tachycardia and an optimal pacemap were used to guide RF ablation.
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Idiopathic Ventricular Tachycardia--characterisation and radiofrequency ablation.
Indian heart journal, 1994Co-Authors: Yash Lokhandwala, Metzger J, Chaginikolaou H, Meijer A, Hein J. J. WellensAbstract:Forty patients (14 women and 26 men; mean age 40 +/- 13 years, range 7 to 60) diagnosed to have Idiopathic Ventricular Tachycardia (right Ventricular 28, left Ventricular 12) underwent electrophysiologic study and radiofrequency catheter ablation. Echocardiography, signal averaging, magnetic resonance imaging and cardiac catheterisation with angiography were used as indicated to rule out identifiable underlying etiologies. Gross localisation of the area of origin of the Ventricular Tachycardia from the surface electrocardiogram could be made in all cases. Accurate localisation of the site of origin was done by activation mapping and pace mapping. Radiofrequency application was successful in achieving a cure in 34 (85%) patients, with a mean of 8.3 +/- 4.7 energy applications and a fluoroscopy time of 38 +/- 19 minutes. Unsuccessful cases were characterised by wide and slurred QRS complexes during Ventricular Tachycardia, possibly indicating a deeper intramyocardial or epicardial site of origin of the Tachycardia. Radiofrequency ablation appears to be the treatment of choice for symptomatic Idiopathic Ventricular Tachycardia, having a high success and safety rate.
Hakan Oral - One of the best experts on this subject based on the ideXlab platform.
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spatial resolution of pace mapping of Idiopathic Ventricular Tachycardia ectopy originating in the right Ventricular outflow tract
Heart Rhythm, 2008Co-Authors: Frank Bogun, Majid Taj, Michael Ting, Hyungjin Myra Kim, Stephen Reich, Eric Good, Krit Jongnarangsin, Aman Chugh, Frank Pelosi, Hakan OralAbstract:Background Pace mapping has been used to identify the site of origin of focal Ventricular arrhythmias. The spatial resolution of pace mapping has not been adequately quantified using currently available three-dimensional mapping systems. Objective The purpose of this study was to determine the spatial resolution of pace mapping in patients with Idiopathic Ventricular Tachycardia or premature Ventricular contractions originating in the right Ventricular outflow tract. Methods In 16 patients with Idiopathic Ventricular Tachycardia/ectopy from the right Ventricular outflow tract, comparisons and classifications of pace maps were performed by two observers (good pace map: match >10/12 leads; inadequate pace map: match ≤10/12 leads) and a customized MATLAB 6.0 program (assessing correlation coefficient and normalized root mean square of the difference (nRMSd) between test and template signals). With an electroanatomic mapping system, the correlation coefficient of each pace map was correlated with the distance between the pacing site and the effective ablation site. The endocardial area within the 10-ms activation isochrone was measured. Results The ablation procedure was effective in all patients. Sites with good pace maps had a higher correlation coefficient and lower nRMSd than sites with inadequate pace maps (correlation coefficient: 0.96 ± 0.03 vs 0.76 ± 0.18, P P 0.94 for correlation coefficient (sensitivity 81%, specificity 89%) and ≤0.54 for nRMSd (sensitivity 76%, specificity 80%). Good pace maps were located a mean of 7.3 ± 5.0 mm from the effective ablation site and had a mean activation time of −24 ± 7 ms. However, in 3 (18%) of 16 patients, the best pace map was inadequate at the effective ablation site, with an endocardial activation time at these sites of −25 ± 12 ms. Pace maps with correlation coefficient ≥0.94 were confined to an area of 1.8 ± 0.6 cm 2 . The 10-ms isochrone measured 1.2 ± 0.7 cm 2 . Conclusion The spatial resolution of a good pace map for targeting Ventricular Tachycardia/ectopy is 1.8 cm 2 in the right Ventricular outflow tract and therefore is inferior to the spatial resolution of activation mapping as assessed by isochronal activation. In approximately 20% of patients, pace mapping is unreliable in identifying the site of origin, possibly due a deeper site of origin and preferential conduction via fibers connecting the focus to the endocardial surface.
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Spatial resolution of pace mapping of Idiopathic Ventricular Tachycardia/ectopy originating in the right Ventricular outflow tract.
Heart rhythm, 2007Co-Authors: Frank Bogun, Majid Taj, Michael Ting, Hyungjin Myra Kim, Stephen Reich, Eric Good, Krit Jongnarangsin, Aman Chugh, Frank Pelosi, Hakan OralAbstract:Background Pace mapping has been used to identify the site of origin of focal Ventricular arrhythmias. The spatial resolution of pace mapping has not been adequately quantified using currently available three-dimensional mapping systems. Objective The purpose of this study was to determine the spatial resolution of pace mapping in patients with Idiopathic Ventricular Tachycardia or premature Ventricular contractions originating in the right Ventricular outflow tract. Methods In 16 patients with Idiopathic Ventricular Tachycardia/ectopy from the right Ventricular outflow tract, comparisons and classifications of pace maps were performed by two observers (good pace map: match >10/12 leads; inadequate pace map: match ≤10/12 leads) and a customized MATLAB 6.0 program (assessing correlation coefficient and normalized root mean square of the difference (nRMSd) between test and template signals). With an electroanatomic mapping system, the correlation coefficient of each pace map was correlated with the distance between the pacing site and the effective ablation site. The endocardial area within the 10-ms activation isochrone was measured. Results The ablation procedure was effective in all patients. Sites with good pace maps had a higher correlation coefficient and lower nRMSd than sites with inadequate pace maps (correlation coefficient: 0.96 ± 0.03 vs 0.76 ± 0.18, P P 0.94 for correlation coefficient (sensitivity 81%, specificity 89%) and ≤0.54 for nRMSd (sensitivity 76%, specificity 80%). Good pace maps were located a mean of 7.3 ± 5.0 mm from the effective ablation site and had a mean activation time of −24 ± 7 ms. However, in 3 (18%) of 16 patients, the best pace map was inadequate at the effective ablation site, with an endocardial activation time at these sites of −25 ± 12 ms. Pace maps with correlation coefficient ≥0.94 were confined to an area of 1.8 ± 0.6 cm 2 . The 10-ms isochrone measured 1.2 ± 0.7 cm 2 . Conclusion The spatial resolution of a good pace map for targeting Ventricular Tachycardia/ectopy is 1.8 cm 2 in the right Ventricular outflow tract and therefore is inferior to the spatial resolution of activation mapping as assessed by isochronal activation. In approximately 20% of patients, pace mapping is unreliable in identifying the site of origin, possibly due a deeper site of origin and preferential conduction via fibers connecting the focus to the endocardial surface.
Luz-maria Rodriguez - One of the best experts on this subject based on the ideXlab platform.
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Catheter‐Based Cryoablation of Postinfarction and Idiopathic Ventricular Tachycardia: Initial Experience in a Selected Population
Journal of cardiovascular electrophysiology, 2009Co-Authors: Carl Timmermans, Randy Manusama, Becker S. N. Alzand, Luz-maria RodriguezAbstract:Cryoablation of Ventricular Tachycardia. Introduction: Transvenous cryoablation has proven to be safe and effective for the treatment of supraVentricular arrhythmias. The aim of this prospective study was to report the feasibility and safety of catheter-based cryoablation for the treatment of postinfarction and Idiopathic Ventricular Tachycardia (VT). Methods and Results: Catheter-based cryoablation was performed in 17 patients (15 men, 58 ± 18 years). VT occurred after a prior myocardial infarction in 10 and was Idiopathic in 7 patients. Cryoablation was performed with a 10-F, 6.5-mm tipped catheter. The ablation site was selected using entrainment mapping techniques for postinfarction VT. The site of the earliest activation time with optimal pace mapping was used for ablation of Idiopathic VT. All targeted VTs (12 postinfarction and 7 Idiopathic) were acute successfully ablated after a median number of 2 applications of 5 minutes with an average temperature of –82 ± 4°C. Mean procedure and fluoroscopy times were 204 ± 52 and 52 ± 20 minutes for postinfarction VT and 203 ± 24 and 38 ± 15 minutes for Idiopathic VT. No cryocatheter or cryoenergy complications were observed. After a follow-up of 6 months, 4 of the 10 patients with postinfarction VT had a recurrence. In 1 of the 7 patients with Idiopathic VT the index arrhythmia recurred. Conclusion: In this small patient population, catheter-based cryoablation of VT was safe and effective. Future studies are needed to evaluate the effect of cryothermy in a larger group of patients, especially those with postinfarction VT. (J Cardiovasc Electrophysiol, Vol. 21, pp. 255–261, March 2010)
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radiofrequency catheter ablation of Idiopathic Ventricular Tachycardia originating in the main stem of the pulmonary artery
Journal of Cardiovascular Electrophysiology, 2002Co-Authors: Carl Timmermans, Luz-maria Rodriguez, Argelia Medeiros, Harry J.g.m. Crijns, Hein J. J. WellensAbstract:Idiopathic Pulmonary Artery Ventricular Tachycardia. We report the case of a patient in whom successful radiofrequency catheter ablation of an Idiopathic Ventricular Tachycardia (VT) originating in the main stem of the pulmonary artery was performed. After successful ablation of the index arrhythmia, which was an Idiopathic right Ventricular outflow tract VT, a second VT with a different QRS morphology was reproducibly induced. Mapping of the second VT revealed the presence of myocardium approximately 2 cm above the pulmonary valve. Application of radiofrequency energy at this site resulted in termination and noninducibility of this VT. After 6-month follow-up, the patient remained free from VT recurrences.
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Radiofrequency catheter ablation of Idiopathic Ventricular Tachycardia originating in the main stem of the pulmonary artery.
Journal of cardiovascular electrophysiology, 2002Co-Authors: Carl Timmermans, Luz-maria Rodriguez, Argelia Medeiros, Harry J.g.m. Crijns, Hein J. J. WellensAbstract:We report the case of a patient in whom successful radiofrequency catheter ablation of an Idiopathic Ventricular Tachycardia (VT) originating in the main stem of the pulmonary artery was performed. After successful ablation of the index arrhythmia, which was an Idiopathic right Ventricular outflow tract VT, a second VT with a different QRS morphology was reproducibly induced. Mapping of the second VT revealed the presence of myocardium approximately 2 cm above the pulmonary valve. Application of radiofrequency energy at this site resulted in termination and noninducibility of this VT. After 6-month follow-up, the patient remained free from VT recurrences.
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predictors for successful ablation of right and left sided Idiopathic Ventricular Tachycardia
American Journal of Cardiology, 1997Co-Authors: Luz-maria Rodriguez, Carl Timmermans, Joep L.r.m. Smeets, Hein J. J. WellensAbstract:Abstract This study reports on predictors for successful radiofrequency (RF) ablation of Idiopathic Ventricular Tachycardia (VT) in 48 patients—35 with right Ventricular (RV) outflow tract and 13 with left Ventricular VT. In RV outflow tract Idiopathic VT, RF ablation was successful in 29 of 35 patients (83%). The following information allowed differentiation between patients with and without a successful RF ablation: >1 induced VT morphology (0 vs 3); presence of delta wave-like beginning of the QRS (2 vs 3) and ≥11 of 12 leads showing a “match” between the clinical VT and the pacemap (28 vs 1). Endocardial activation times were not different between both groups (−15 ± 18 vs −4 ± 5 ms). In left ventricle Idiopathic VT, RF ablation was successful in 12 of 13 patients (92%). In patients who underwent successful ablation, 1 VT morphology was induced and no delta wave-like beginning of the QRS was present; a correlation between clinical VT and the pacemap ≥11 of 12 leads was found and the endocardial activation time preceded the QRS (range of −5 to −58 ms [mean −30 ± 14]). Purkinje activity was observed in 5 of 7 patients with an Idiopathic VT originating from the inferoposterior region but not from the inferoapical region of the left ventricle. Four patients (14%) with RV outflow tract Idiopathic VT had recurrence during a mean follow-up of 2 to 50 months (mean 30 ± 12). Thus, (1) in RV outflow tract Idiopathic VT a good pacemap was more important than an early endocardial activation time; (2) an optimal pacemap as well as an early endocardial activation time were important predictors for successful ablation of the left ventricle Idiopathic VT; (3) Purkinje activity was recorded in VTs arising in the inferoposterior region of the left ventricle; and (4) factors for unsuccessful ablation for Idiopathic VT were >1 induced VT morphology, a delta wave-like beginning of the QRS, and a VT/pacemap correlation
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Radiofrequency catheter ablation of Idiopathic Ventricular Tachycardia originating in the anterior fascicle of the left bundle branch.
Journal of cardiovascular electrophysiology, 1996Co-Authors: Luz-maria Rodriguez, Carl Timmermans, Joep L.r.m. Smeets, Hans J. Trappe, Hein J. J. WellensAbstract:Ablation of an Anterior Fascicular Idiopathic VT. Introduction: Idiopathic Ventricular Tachycardia (VT) originating in or close to the anterior fascicle of the left bundle is rare. A patient with no structural heart disease and VT with a right bundle branch block configuration and right-axis deviation underwent an electrophysiologic examination. Methods and Results: Both endocardial activation mapping during VT and pacemapping were performed via a transseptal approach to localize the site of origin of the VT. Endocardial recordings of the His bundle and the posterior and anterior fascicles of the left bundle branch revealed an origin of the VT in or close to the anterior fascicle. The Purkinje potential at that site preceded the QRS complex by 20 msec, with pacemapping showing an optimal match between the paced rhythm and the clinical VT. RF energy delivered at this site terminated the VT. A left anterior nemiblock appeared after RF ablation. Ten months later, the patient is free from recurrences of VT. Conclusions: Idiopathic VT originating in or close to the anterior fascicle was cured by RF ablation. A Purkinje potential preceding the QRS during Tachycardia and an optimal pacemap were used to guide RF ablation.
Katsuro Shimomura - One of the best experts on this subject based on the ideXlab platform.
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localization of optimal ablation site of Idiopathic Ventricular Tachycardia from right and left Ventricular outflow tract by body surface ecg
Circulation, 1998Co-Authors: Shiro Kamakura, Wataru Shimizu, Kiyotaka Matsuo, Atsushi Taguchi, Kazuhiro Suyama, Takashi Kurita, Naohiko Aihara, Tohru Ohe, Katsuro ShimomuraAbstract:Background—Idiopathic Ventricular Tachycardia (VT) is known to arise from the right Ventricular (RV) and left Ventricular outflow tracts (LVOT). However, reliable noninvasive methods to localize th...
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Sudden Death in a patient With Apparent Idiopathic Ventricular Tachycardia
Japanese circulation journal, 1996Co-Authors: Hiroshi Tada, Shiro Kamakura, Wataru Shimizu, Takashi Kurita, Naohiko Aihara, Tohru Ohe, Chikao Yutani, Katsuro ShimomuraAbstract:Idiopathic Ventricular Tachycardia is widely believed to carry a favorable prognosis, although there have also been reports of sudden cardiac deaths. We present a case of sudden death in a patient with apparent Idiopathic right Ventricular Tachycardia. This patient had long-standing and exercise-related symptoms, an essentially negative non-invasive cardiac evaluation, and spontaneous and inducible Ventricular Tachycardia of left bundle branch block and inferior axis morphology, that was treated with propranolol. After an uneventful 5-year course, the patient died suddenly. Postmortem examination revealed a severely dilated right ventricle and significant replacement of the right Ventricular wall with adipose tissue. Interstitial fibrosis was also seen, but only to a very slight degree. (Jpn Circ J 1996; 60: 133 - 136)
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Spectral analysis of signal-averaged electrocardiograms in patients with Idiopathic Ventricular Tachycardia of left Ventricular origin
Circulation, 1992Co-Authors: Osamu Kinoshita, Shiro Kamakura, Takashi Kurita, Naohiko Aihara, Tohru Ohe, Chikao Yutani, Mokuo Matsuhisa, Hiroshi Takaki, Katsuro ShimomuraAbstract:BACKGROUNDThe signal-averaged ECG has been used to detect late potentials, and it is considered a noninvasive marker for areas of slow conduction requisite for reentrant arrhythmia. Late potentials are not usually found in patients with Idiopathic Ventricular Tachycardia (VT); nevertheless, fragmented electrograms are often recorded in those patients during endocardial mapping. The purpose of this study was to investigate the spectral content of the signal-averaged ECGs with use of fast Fourier transform analysis (FFT) in patients with Idiopathic VT of left Ventricular origin.METHODS AND RESULTSSignal-averaged ECGs were recorded in 12 patients with Idiopathic VT originating from the left ventricle (group 1) and 25 age-matched normal volunteers (group 2). Frequency analysis with FFT was performed with a Blackman-Harris window in a segment length of 120 msec from 40 msec before the end of the QRS complex, and the frequency spectrum was displayed in a three-dimensional graph. Area ratio 1 (area of 20-50 Hz/a...
Carl Timmermans - One of the best experts on this subject based on the ideXlab platform.
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Catheter‐Based Cryoablation of Postinfarction and Idiopathic Ventricular Tachycardia: Initial Experience in a Selected Population
Journal of cardiovascular electrophysiology, 2009Co-Authors: Carl Timmermans, Randy Manusama, Becker S. N. Alzand, Luz-maria RodriguezAbstract:Cryoablation of Ventricular Tachycardia. Introduction: Transvenous cryoablation has proven to be safe and effective for the treatment of supraVentricular arrhythmias. The aim of this prospective study was to report the feasibility and safety of catheter-based cryoablation for the treatment of postinfarction and Idiopathic Ventricular Tachycardia (VT). Methods and Results: Catheter-based cryoablation was performed in 17 patients (15 men, 58 ± 18 years). VT occurred after a prior myocardial infarction in 10 and was Idiopathic in 7 patients. Cryoablation was performed with a 10-F, 6.5-mm tipped catheter. The ablation site was selected using entrainment mapping techniques for postinfarction VT. The site of the earliest activation time with optimal pace mapping was used for ablation of Idiopathic VT. All targeted VTs (12 postinfarction and 7 Idiopathic) were acute successfully ablated after a median number of 2 applications of 5 minutes with an average temperature of –82 ± 4°C. Mean procedure and fluoroscopy times were 204 ± 52 and 52 ± 20 minutes for postinfarction VT and 203 ± 24 and 38 ± 15 minutes for Idiopathic VT. No cryocatheter or cryoenergy complications were observed. After a follow-up of 6 months, 4 of the 10 patients with postinfarction VT had a recurrence. In 1 of the 7 patients with Idiopathic VT the index arrhythmia recurred. Conclusion: In this small patient population, catheter-based cryoablation of VT was safe and effective. Future studies are needed to evaluate the effect of cryothermy in a larger group of patients, especially those with postinfarction VT. (J Cardiovasc Electrophysiol, Vol. 21, pp. 255–261, March 2010)
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radiofrequency catheter ablation of Idiopathic Ventricular Tachycardia originating in the main stem of the pulmonary artery
Journal of Cardiovascular Electrophysiology, 2002Co-Authors: Carl Timmermans, Luz-maria Rodriguez, Argelia Medeiros, Harry J.g.m. Crijns, Hein J. J. WellensAbstract:Idiopathic Pulmonary Artery Ventricular Tachycardia. We report the case of a patient in whom successful radiofrequency catheter ablation of an Idiopathic Ventricular Tachycardia (VT) originating in the main stem of the pulmonary artery was performed. After successful ablation of the index arrhythmia, which was an Idiopathic right Ventricular outflow tract VT, a second VT with a different QRS morphology was reproducibly induced. Mapping of the second VT revealed the presence of myocardium approximately 2 cm above the pulmonary valve. Application of radiofrequency energy at this site resulted in termination and noninducibility of this VT. After 6-month follow-up, the patient remained free from VT recurrences.
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Radiofrequency catheter ablation of Idiopathic Ventricular Tachycardia originating in the main stem of the pulmonary artery.
Journal of cardiovascular electrophysiology, 2002Co-Authors: Carl Timmermans, Luz-maria Rodriguez, Argelia Medeiros, Harry J.g.m. Crijns, Hein J. J. WellensAbstract:We report the case of a patient in whom successful radiofrequency catheter ablation of an Idiopathic Ventricular Tachycardia (VT) originating in the main stem of the pulmonary artery was performed. After successful ablation of the index arrhythmia, which was an Idiopathic right Ventricular outflow tract VT, a second VT with a different QRS morphology was reproducibly induced. Mapping of the second VT revealed the presence of myocardium approximately 2 cm above the pulmonary valve. Application of radiofrequency energy at this site resulted in termination and noninducibility of this VT. After 6-month follow-up, the patient remained free from VT recurrences.
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predictors for successful ablation of right and left sided Idiopathic Ventricular Tachycardia
American Journal of Cardiology, 1997Co-Authors: Luz-maria Rodriguez, Carl Timmermans, Joep L.r.m. Smeets, Hein J. J. WellensAbstract:Abstract This study reports on predictors for successful radiofrequency (RF) ablation of Idiopathic Ventricular Tachycardia (VT) in 48 patients—35 with right Ventricular (RV) outflow tract and 13 with left Ventricular VT. In RV outflow tract Idiopathic VT, RF ablation was successful in 29 of 35 patients (83%). The following information allowed differentiation between patients with and without a successful RF ablation: >1 induced VT morphology (0 vs 3); presence of delta wave-like beginning of the QRS (2 vs 3) and ≥11 of 12 leads showing a “match” between the clinical VT and the pacemap (28 vs 1). Endocardial activation times were not different between both groups (−15 ± 18 vs −4 ± 5 ms). In left ventricle Idiopathic VT, RF ablation was successful in 12 of 13 patients (92%). In patients who underwent successful ablation, 1 VT morphology was induced and no delta wave-like beginning of the QRS was present; a correlation between clinical VT and the pacemap ≥11 of 12 leads was found and the endocardial activation time preceded the QRS (range of −5 to −58 ms [mean −30 ± 14]). Purkinje activity was observed in 5 of 7 patients with an Idiopathic VT originating from the inferoposterior region but not from the inferoapical region of the left ventricle. Four patients (14%) with RV outflow tract Idiopathic VT had recurrence during a mean follow-up of 2 to 50 months (mean 30 ± 12). Thus, (1) in RV outflow tract Idiopathic VT a good pacemap was more important than an early endocardial activation time; (2) an optimal pacemap as well as an early endocardial activation time were important predictors for successful ablation of the left ventricle Idiopathic VT; (3) Purkinje activity was recorded in VTs arising in the inferoposterior region of the left ventricle; and (4) factors for unsuccessful ablation for Idiopathic VT were >1 induced VT morphology, a delta wave-like beginning of the QRS, and a VT/pacemap correlation
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Radiofrequency catheter ablation of Idiopathic Ventricular Tachycardia originating in the anterior fascicle of the left bundle branch.
Journal of cardiovascular electrophysiology, 1996Co-Authors: Luz-maria Rodriguez, Carl Timmermans, Joep L.r.m. Smeets, Hans J. Trappe, Hein J. J. WellensAbstract:Ablation of an Anterior Fascicular Idiopathic VT. Introduction: Idiopathic Ventricular Tachycardia (VT) originating in or close to the anterior fascicle of the left bundle is rare. A patient with no structural heart disease and VT with a right bundle branch block configuration and right-axis deviation underwent an electrophysiologic examination. Methods and Results: Both endocardial activation mapping during VT and pacemapping were performed via a transseptal approach to localize the site of origin of the VT. Endocardial recordings of the His bundle and the posterior and anterior fascicles of the left bundle branch revealed an origin of the VT in or close to the anterior fascicle. The Purkinje potential at that site preceded the QRS complex by 20 msec, with pacemapping showing an optimal match between the paced rhythm and the clinical VT. RF energy delivered at this site terminated the VT. A left anterior nemiblock appeared after RF ablation. Ten months later, the patient is free from recurrences of VT. Conclusions: Idiopathic VT originating in or close to the anterior fascicle was cured by RF ablation. A Purkinje potential preceding the QRS during Tachycardia and an optimal pacemap were used to guide RF ablation.
