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Three-dimensional transmural mapping to guide ventricular arrhythmia ablation

      Idiopathic ventricular arrhythmias (VAs) lead to cardiomyopathy and worsened outcomes whether symptomatic or not
      • Yarlagadda R.K.
      • Iwai S.
      • Stein K.M.
      • et al.
      Reversal of cardiomyopathy in patients with repetitive monomorphic ventricular ectopy originating from the right ventricular outflow tract.
      ,
      • Al-Khatib S.M.
      • Stevenson W.G.
      • Ackerman M.J.
      • et al.
      2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
      and are commonly treated by ablation. While VAs from the right and left outflow tracts are straightforward to ablate, this is not true for all locations.
      • Al-Khatib S.M.
      • Stevenson W.G.
      • Ackerman M.J.
      • et al.
      2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
      In particular, arrhythmias from the left ventricular summit or interventricular septum, which constitute ~10% of all idiopathic cases, are more difficult to map and ablate.
      • Al-Khatib S.M.
      • Stevenson W.G.
      • Ackerman M.J.
      • et al.
      2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
      Accordingly, there is great interest in novel approaches to guide intervention in such patients.
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      References

        • Yarlagadda R.K.
        • Iwai S.
        • Stein K.M.
        • et al.
        Reversal of cardiomyopathy in patients with repetitive monomorphic ventricular ectopy originating from the right ventricular outflow tract.
        Circulation. 2005; 112: 1092-1097
        • Al-Khatib S.M.
        • Stevenson W.G.
        • Ackerman M.J.
        • et al.
        2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
        J Am Coll Cardiol. 2018; 72: e91-e220
        • Pothenini N.V.K.
        • Garg L.
        • Guandalini G.
        • Lin D.
        • Supple G.E.
        • Garcia F.C.
        A novel approach to mapping and ablation of septal outflow tract ventricular arrhythmias: Insights from multipolar intraseptal recordings.
        Heart Rhythm. 2021; 18: 1445-1451
        • Briceno D.F.
        • Enriquez A.
        • Liang J.J.
        • et al.
        Septal coronary venous mapping to guide substrate characterization and ablation of intramural septal ventricular arrhythmia.
        JACC Clin Electrophysiol. 2019; 5: 789-800
        • Komatsu Y.
        • Nogami A.
        • Shinoda Y.
        • et al.
        Idiopathic ventricular arrhythmias originating from the vicinity of the communicating vein of cardiac venous systems at the left ventricular summit.
        Circ Arrhythm Electrophysiol. 2018; 11e005386
        • Jauregui Abularach M.E.
        • Campos B.
        • et al.
        Ablation of ventricular arrhythmias arising near the anterior epicardial veins from the left sinus of Valsalva region: ECG features, anatomic distance, and outcome.
        Heart Rhythm. 2012; 9: 865-873
        • Nagashima K.
        • Choi E.K.
        • Lin K.Y.
        • et al.
        Ventricular arrhythmias near the distal great cardiac vein: challenging arrhythmia for ablation.
        Circ Arrhythm Electrophysiol. 2014; 7: 906-912
        • Liao H.
        • Wei W.
        • Tanager K.S.
        • et al.
        Left ventricular summit arrhythmias with an abrupt V3 transition: anatomy of the aortic interleaflet triangle vantage point.
        Heart Rhythm. 2021; 18: 10-19
        • Nguyen D.T.
        • Tzou W.S.
        • Sandhu A.
        • et al.
        Prospective multicenter experience with cooled radiofrequency ablation using high impedance irrigant to target deep myocardial substrate refractory to standard ablation.
        JACC Clin Electrophysiol. 2018; 4: 1176-1185
        • Sivagangabalan G.
        • Barry M.A.
        • Huang K.
        • et al.
        Bipolar ablation of the interventricular septum is more efficient at creating a transmural line than sequential unipolar ablation.
        Pacing Clin Electrophysiol. 2010; 33: 16-26
        • Tokuda M.
        • Sobieszczyk P.
        • Eisenhauer A.C.
        • et al.
        Transcoronary ethanol ablation for recurrent ventricular tachycardia after failed catheter ablation: an update.
        Circ Arrhythm Electrophysiol. 2011; 4: 889-896
        • Stevenson W.G.
        • Tedrow U.B.
        • Reddy V.
        • et al.
        Infusion needle radiofrequency ablation for treatment of refractory ventricular arrhythmias.
        J Am Coll Cardiol. 2019; 73: 1413-1425

      Linked Article

      • A novel approach to mapping and ablation of septal outflow tract ventricular arrhythmias: Insights from multipolar intraseptal recordings
        Heart RhythmVol. 18Issue 8
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          Catheter ablation is the preferred treatment option for idiopathic ventricular arrhythmias (VAs).1 Refinements in mapping and ablation technologies have led to a marked improvement in success rates of catheter ablation. Despite these improvements, VAs arising from specific anatomical locations such as the left ventricular summit (LVS) and the interventricular septum pose specific challenges to mapping and delivery of radiofrequency (RF) energy. A major obstacle in treating VAs from these sites is the inaccessibility of mapping from the endocardium or epicardium or the presence of intramural substrate that is challenging to record and target efficiently with standard techniques.
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