Impact of Intramural Scar on Mapping and Ablation of Premature Ventricular Complexes.
cardiac magnetic resonance
catheter ablation
premature ventricular contraction
Journal
JACC. Clinical electrophysiology
ISSN: 2405-5018
Titre abrégé: JACC Clin Electrophysiol
Pays: United States
ID NLM: 101656995
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
received:
10
08
2020
revised:
02
11
2020
accepted:
03
11
2020
pubmed:
29
12
2020
medline:
25
2
2023
entrez:
28
12
2020
Statut:
ppublish
Résumé
This study sought to determine intramural scar characteristics associated with successful premature ventricular complex (PVC) ablations. Ablating ventricular arrhythmias (VAs) originating from intramural scarring can be challenging. Imaging of intramural scar location may help to determine whether the scar is within reach of the ablation catheter. Mapping and ablation of premature ventricular complexes (PVCs) was performed in a consecutive series of patients with intramural scarring and frequent PVCs. Data from delayed enhanced cardiac magnetic resonance were assessed and the proximity of the endocardium containing the breakout site to the intramural scar was correlated with outcomes. Fifty-six patients were included, and intramural VAs were successfully targeted in 42 patients (75%) and ablation failed in 14 patients (25%). Scarring was more superficial to the endocardium in patients with successful ablations compared with patients with failed procedures (0.35 mm [interquartile range (IQR): 0.22 to 1.20 mm] vs. 2.45 mm [IQR: 1.60 to 3.13 mm]; p < 0.001). In 18 (32%) patients, ablation at the breakout site resulted in a significant change of the PVC-QRS morphology that could successfully be ablated in 9 of 12 patients from another anatomical aspect of the wall harboring the intramural scar. The scar was larger in size (1.79 cm VAs in patients with intramural scaring can be successfully ablated especially if the intramural scar is within close proximity to the anatomic area containing the breakout site. Changes in the QRS-PVC morphology often precede successful ablation at another breakout site and indicate larger intramural scars.
Sections du résumé
OBJECTIVES
This study sought to determine intramural scar characteristics associated with successful premature ventricular complex (PVC) ablations.
BACKGROUND
Ablating ventricular arrhythmias (VAs) originating from intramural scarring can be challenging. Imaging of intramural scar location may help to determine whether the scar is within reach of the ablation catheter.
METHODS
Mapping and ablation of premature ventricular complexes (PVCs) was performed in a consecutive series of patients with intramural scarring and frequent PVCs. Data from delayed enhanced cardiac magnetic resonance were assessed and the proximity of the endocardium containing the breakout site to the intramural scar was correlated with outcomes.
RESULTS
Fifty-six patients were included, and intramural VAs were successfully targeted in 42 patients (75%) and ablation failed in 14 patients (25%). Scarring was more superficial to the endocardium in patients with successful ablations compared with patients with failed procedures (0.35 mm [interquartile range (IQR): 0.22 to 1.20 mm] vs. 2.45 mm [IQR: 1.60 to 3.13 mm]; p < 0.001). In 18 (32%) patients, ablation at the breakout site resulted in a significant change of the PVC-QRS morphology that could successfully be ablated in 9 of 12 patients from another anatomical aspect of the wall harboring the intramural scar. The scar was larger in size (1.79 cm
CONCLUSIONS
VAs in patients with intramural scaring can be successfully ablated especially if the intramural scar is within close proximity to the anatomic area containing the breakout site. Changes in the QRS-PVC morphology often precede successful ablation at another breakout site and indicate larger intramural scars.
Identifiants
pubmed: 33358663
pii: S2405-500X(20)31125-7
doi: 10.1016/j.jacep.2020.11.004
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
733-741Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 American College of Cardiology Foundation. All rights reserved.
Déclaration de conflit d'intérêts
FUNDING SUPPORT AND Author Disclosures This research was supported by funding from the French National Research Agency (Grant Nos. Equipex MUSIC ANR-11-EQPX-0030 and IHU LIRYC ANR-10-IAHU-04 to Drs. Cochet, Jais, and Juhoor) and the European Research Council (Grant No. 715093 to Drs. Cochet, Jais, and Juhoor). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.