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Surgical procedure for targeting arrhythmogenic substrates in the treatment of ventricular tachycardia associated with cardiac tumors

Published:August 30, 2019DOI:https://doi.org/10.1016/j.hrthm.2019.08.025

      Background

      Complete tumor resection is a standard strategy in the surgical treatment of ventricular tachycardia (VT) associated with cardiac tumors. Recently, an intraoperative electroanatomic mapping system (CARTO) has enabled surgeons to target the localized arrhythmogenic substrate for partial resection and/or cryoablation in nonresectable cardiac tumors.

      Objective

      The purpose of this study was to evaluate the surgical procedures and late outcomes of the treatment of VT associated with cardiac tumors.

      Methods

      We examined six patients (age 1–65 years) who had undergone surgical treatment of VT associated with cardiac tumors between 2010 and 2016. The 4 pathologies of the cardiac tumors were lipoma 2, fibroma 2, hemangioma 1, and lymphoma 1. Intraoperative epicardial mapping using CARTO was performed in 5 patients(80%). Surgical procedures and long-term outcomes were evaluated.

      Results

      Arrhythmogenic substrates with abnormal electrograms, such as fractionated or late potential, were identified locally or circumferentially beside the tumor in every patient. Complete tumor resection with cryoablation was performed in 3 patients. Two patients underwent partial tumor resection with cryoablation. Cryoablation without tumor resection was performed in 1 patient. No mortality and morbidity occurred. Additional catheter ablation was required in 2 patients to treat occurrence of nonclinical VT and induction of clinical VT during hospital stay. Mean follow-up time was 90 ± 52.5 months. There was no recurrence of clinical VT.

      Conclusion

      The outcomes of surgical treatment of VT associated with cardiac tumors were excellent. Intraoperative CARTO mapping was beneficial to eliminate the VT substrates associated with nonresectable cardiac tumors.

      Keywords

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      References

        • Sakamoto S.
        • Nitta T.
        • Murata H.
        • et al.
        Electroanatomical mapping-assisted surgical treatment of incessant ventricular tachycardia associated with an intramyocardial giant lipoma.
        J Interv Card Electrophysiol. 2012; 33: 109-112
        • Nitta T.
        • Kurita J.
        • Murata H.
        • et al.
        Intraoperative electroanatomic mapping.
        Ann Thorac Surg. 2012; 93: 1285-1288
        • Sakamoto S.
        • Shibata M.
        • Murata H.
        • Nitta T.
        Intraoperative cardiac mapping in the treatment of an infant congenital fibroma.
        Ann Thorac Surg. 2015; 99: 1064-1066
        • Stockhausen K.T.
        Declaration of Helsinki: revising ethical research guidelines for the 21st century.
        Med J Aust. 2000; 172: 252-253
        • McAllister Jr., H.A.
        • Hall R.J.
        • Cooley D.A.
        Tumors of the heart and pericardium.
        Curr Probl Cardiol. 1999; 24: 57-116
        • Takach T.J.
        • Reul G.J.
        • Ott D.A.
        • Cooley D.A.
        Primary cardiac tumors in infants and children: immediate and long-term operative results.
        Ann Thorac Surg. 1996; 62: 559-564
        • Miyake C.Y.1
        • Del Nido P.J.
        • Alexander M.E.
        • et al.
        Cardiac tumors and associated arrhythmias in pediatric patients, with observations on surgical therapy for ventricular tachycardia.
        J Am Coll Cardiol. 2011; 58: 1903-1909
        • Nathan M.
        • Fabozzo A.
        • Geva T.
        • Walsh E.
        • del Nido P.J.
        Successful surgical management of ventricular fibromas in children.
        J Thorac Cardiovasc Surg. 2014; 148: 2602-2608
        • Sheldon R.
        • Isaac D.
        Metastatic melanoma to the heart presenting with ventricular tachycardia.
        Chest. 1991; 99: 1296-1298
        • Iijima K.
        • Chinushi M.
        • Izumi D.
        • Aizawa Y.
        Ventricular tachycardia due to intramyocardial fibroma.
        J Cardiovasc Electrophysiol. 2011; 22: 825-826
        • Cassidy D.M.
        • Vassallo J.A.
        • Buxton A.E.
        • et al.
        The value of catheter mapping during sinus rhythm to localize site of origin of ventricular tachycardia.
        Circulation. 1984; 69: 1103-1110
        • Dor V.
        • Sabatier M.
        • Montiglio F.
        • et al.
        Results of nonguided subtotal endocardiectomy associated with left ventricular reconstruction in patients with ischemic ventricular arrhythmias.
        J Thorac Cardiovasc Surg. 1994; 107: 1301-1307
        • Sartipy U.1
        • Albåge A.
        • Straat E.
        • Insulander P.
        • Lindblom D.
        Surgery for ventricular tachycardia in patients undergoing left ventricular reconstruction by the Dor procedure.
        Ann Thorac Surg. 2006; 81: 65-71
        • Burke A.P.
        • Rosado-de-Christenson M.
        • Templeton P.A.
        • Virmani R.
        Cardiac fibroma: clinicopathologic correlates and surgical treatment.
        J Thorac Cardiovasc Surg. 1994; 108: 862-870
        • Cho J.M.
        • Danielson G.K.
        • Puga F.J.
        • et al.
        Surgical resection of ventricular cardiac fibromas: early and late results.
        Ann Thorac Surg. 2003; 76: 1929-1934
        • Delmo Walter E.M.
        • Javier M.F.
        • et al.
        primary cardiac tumors in infants and children: surgical strategy and long-term outcome.
        Ann Thorac Surg. 2016; 102: 2062-2069
        • Jones J.P.
        • Ramcharan T.
        • Chaudhari M.
        • et al.
        Ventricular fibromas in children, arrhythmia risk, and outcomes: a multicenter study.
        Heart Rhythm. 2018; 15: 1507-1512