Background
Methods
Study population
Pre-procedural management
Procedural setup
Procedural workflow
Epicardial approach
Fluoroscopy minimising approach
The use of intra-cardiac echocardiography
Definition of procedural parameters, procedural success, complications and follow-up
Statistical analysis
Results
All (n = 52) | Group 1 (n = 25) | Group 2 (n = 27) | |
---|---|---|---|
Age (years) | 53.4 ± 17.8 | 62 .8 ± 12.5 | 44.7 ± 17.7* |
Male gender [number (%)] | 38 (73.1) | 24 (96%) | 14 (51.9)* |
Body Mass Index (kg/m2) | 25.6 ± 5.2 | 27.1 ± 3.8 | 24.2 ± 6.0** |
Arterial hypertension [number (%)] | 27 (51.9) | 19 (76) | 8 (29.6) |
Hyperlipidemia [number (%)] | 27 (51.9) | 19 (76) | 8 (29.6) |
Diabetes mellitus [number (%)] | 5 (9.6) | 3 (12) | 2 (7.4) |
Ischaemic cardiomyopathy [number (%)] | 19 (36.5) | 19 (76) | 0 |
Non-ischaemic cardiomyopathy [number (%)] | 5 (9.6) | 5 (20) | 0 |
Congenital heart disease [number (%)] | 1 (1.9) | 1 (4) | 0 |
LVEF (%) | 49.5 ± 13.1 | 40.8 ± 10.4 | 57.5 ± 9.7* |
LVEDV (ml) | 154.5 ± 62.4 | 194.7 ± 64.3 | 117.1 ± 28.5* |
RV dysfunction [number (%)] | 5 (9.6) | 4 (16) | 1 (3.7) |
CIED present[number (%)] | 16 (30.7) | 16 (64) | 0 |
AAD non-amiodarone [number (%)] | 34 (65.3) | 21 (84) | 13 (48.1) |
Amiodarone [number (%)] | 9 (17.3) | 7 (28) | 2 (7.4) |
Sustained VT [number (%)] | 15 (28.8) | 10 (40) | 5 (18.5) |
Electrical storm [number (%)] | 8 (15.4) | 8 (32) | 0 |
Tachycardia induced cardiomyopathy [number (%)] | 4 (7.6) | 0 | 4 (14.8) |
Procedural parameters
Group 1 (n = 31) | Group 2 (n = 29) | |
---|---|---|
Septal substrate related VT [number (%)] | 8 (25.8) | – |
Epicardial substrate related VT [number (%)] | 6 (19.4) | – |
Outflow tract ectopy/VT [number (%)] | – | 18 (62.1) |
Fascicular VT [number (%)] | – | 2 (6.9) |
Moderator band ectopy/VT [number (%)] | – | 2 (6.9) |
Postero-septal process ectopy/VT [number (%)] | – | 4 (13.8) |
Papillary muscle ectopy/VT [number (%)] | – | 1 (3.4) |
Other substrate/origin locations [number (%)] | 28 (90.3) | 4 (13.8) |
Total procedural time (min) | 256.9 ± 71.7 | 123.6 ± 42.2* |
Number of ablations (number) | 80.9 ± 40.5 | 15.4 ± 8.6* |
Total ablation time (seconds) | 3240 ± 1690 | 537 ± 357 * |
Trans-septal punctures [number (%)] | 28 (90.3) | 8 (27.6) * |
Epicardial mapping and ablation [number (%)] | 3 (9.7) | 4 (13.8) |
Procedures with high density mapping [number (%)] | 25 (80.6) | 4 (13.8) * |
Procedures with general anaesthesia [number (%)] | 6 (19.4) | 4 (13.8) |
Overall Procedural Success Rate [number (%)] | 24 (77.4) | 26 (89.7) |
Repeat procedures [number (%)] | 6 (19.4) | 2 (6.9) |
Procedures with fluoroscopy [number (%)] | 3 (9.7) | 4 (13.8) |
Fluoroscopy time (min) | 21.2 ± 5 | 8.3 ± 4 |
DAP per procedure [Gycm2 (SD)], if fluoroscopy used | 48.6 ± 23 (3 procedures) | 25.4 ± 14 (4 procedures) |
Procedural outcomes
Use of fluoroscopy
Procedural adverse events
All (n = 60) | Group 1 (n = 31) | Group 2 (n = 29) | |
---|---|---|---|
Stroke/TIA | 0 | 0 | 0 |
Pericardial tamponade | 1 (1.7) | 0 | 1 (3.4) |
RV perforation | 1 (1.7) | 1 (3.2) | 0 |
Pneumothorax | 0 | 0 | 0 |
Hematothorax | 0 | 0 | 0 |
PSA surgery/intervention | 1 (1.7) | 1 (3.2) | 0 |
CIED lead dislocation | 0 | 0 | 0 |
Overall | 3 (5) | 2 (6.4) | 1 (3.4) |
Discussion
Author, year | ZF/MinF/F | Number of patients | Type of study | Type of VA | Procedural duration | OSR | RR | CR | Epicardial ablation, % of procedures | Use of fluoroscopy | Fluoroscopy time and dose | Use of ICE, % of procedures |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Our study, 2021 | MinF | 52 | Retrospective, consecutive pts | PVC, Idiopathic VT and SHD related VT (NICM, ICM) | 123.6 ± 42.2 min for PVC and idiopathic VT, 256.9 ± 71.7 min for SHD related VT | 89.7% for PVC and idiopathic VT, 77.4% for SHD related VT | 29.6% for PVC and idiopathic VT, 32% for SHD related VT | 5% | Yes, in 10% for SHD related VT | Yes, 14% for PVC and idiopathic VT, 10% for SHD related VT | 8.3 ± 4 min and 25.4 ± 14 Gycm2 when used for PVC and idiopathic VT; 21.2 ± 5 min and 48.6 ± 32 Gycm2 when used in SHD related VT | Yes, 100% |
Dinov et al., 2014 | F | 227 | Prospective | SHD related VT (NICM, ICM) | 181 ± 63.6 min for NICM and 155 ± 49 min for ICM | 66.7% for NICM and 77.4% ICM | 59.5% for NICM and 43% for ICM | 11.1% for NICM and ICM | Yes, 9% | Yes, 100% of procedures | 39 ± 22.4 min for NICM and 26 ± 19.1 min for ICM, dose not reported | No |
Tanawuttivat et al., 2015 | F | 815 in 8 different studies | Review with analysis | Idiopathic/outflow tract VT | Not reported in the review | 76–100% | 0–23% | 0–3% | No | Yes | Not reported in the review | No |
Kumar et al., 2016 | F | 695 | Retrospective, consecutive pts | Idiopathic VT and SHD related VT (NICM, ICM) | Not reported | 79% for idiopathic VT, 60% for NICM and 56% for ICM | At 6 years FU: 23% for idiopathic VT, 62% for NICM and 46% for ICM | 3.7% for idiopathic VT, 6.7% for NICM, 8.3% for ICM | Yes, 3% for idiopathic VT, 30% for NICM and 8% for ICM | Yes | 31.3 ± 20 min for idiopathic VT, 43 ± 21.6 for NICM and 45.1 ± 30.2 for ICM, dose not reported | No |
Lamberti et al., 2015 | ZF | 19 | Retrospective, consecutive pts | PVC, idiopathic VT | 170.2 ± 45.7 min | 100% | 10.5% | 0 | No | No | 0 | Yes, 100% |
Sanchez et al., 2016 | ZF | 16 | Retrospective, consecutive pts | PVC, Idiopathic VT and SHD related VT (aetiology not specified) | 150 ± 45 min | 100% | Not reported | 0 | No | No | 0 | Yes, 75% |
Razminia et al., 2017 | ZF | 44 | Retrospective, consecutive pts | PVC, Idiopathic VT and SHD related VT (ICM) | 201.9 min for PVC, 257.5 min for idiopathic VT and SHD related VT | 93.3% for PVC, 100% for idiopathic VT and SHD related VT | 6.6 for PVC, 21.4 for idiopathic VT and SHD related VT | 3.3% for PVC, 0 for idiopathic VT and SHD related VT | No | No | 0 | Yes, % not specified |
Giaccardi et al., 2019 | ZF | 7 | Retrospective | PVC, VT (aetiology not specified) | 75 min for PVC, 128 ± 21 min for VT | 100% | 0 | 0 | No | No | 0 | No |
Sadek et al., 2019 | ZF | 10 | Prospective | PVC, SHD related VT (aetiology not specified) | Not reported | 100% | 0 for PVC, 17% for SHD related VT | 0 | No | No | 0 | Yes, 100% |
Cano et al., 2016 | MinF | 41 | Prospective | SHD related VT (NICM, ICM) | 204 ± 61 min | 66% | 7.3% | 4.9% | Yes, 16% | Yes | 6.08 (1.51–12.36) min and 10.8 (2.9–41.1) Gycm2 | No |
Wang et al., 2017 | MinF | 160 | Prospective, multi-centre | PVC, idiopathic VT | 77.1 ± 33.8 min | 84.1% | 1.9% | 1.2% | No | Yes, 5.6% of procedures | 1.5 ± 0.3 min when used, dose not reported | No |