Choi, Eue-Keun; Nagashima, Koichi; Lin, Kaity Y; Kumar, Saurabh; Barbhaiya, Chirag R; Baldinger, Samuel H; Reichlin, Tobias; Michaud, Gregory F; Couper, Gregory S; Stevenson, William G; John, Roy M
Heart rhythm : the official journal of the Heart Rhythm Society
2015Jun ; 12 ( 6 ) :1128-36.
PMID : 25697752
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Choi, Eue-Keun -
Nagashima, Koichi -
Lin, Kaity Y -
Kumar, Saurabh -
Barbhaiya, Chirag R -
Baldinger, Samuel H -
Reichlin, Tobias -
Michaud, Gregory F -
Couper, Gregory S -
Stevenson, William G -
John, Roy M -
ABSTRACT
BACKGROUND: Ventricular arrhythmias (VAs) from the left ventricular outflow tract (LVOT) region can be inaccessible for ablation because of epicardial fat or overlying coronary arteries. OBJECTIVE: We describe surgical cryoablation of this type of VA.
METHODS: From March 2009 to 2014, 190 consecutive patients with VAs originating from the LVOT underwent ablation at our institution. Four patients (2%) underwent surgical cryoablation for highly symptomatic VAs after failing catheter ablation.
RESULTS: In all patients, endocardial or percutaneous epicardial mapping was consistent with origin in the LVOT. In 2 patients, the points of earliest activation during VAs were marked with a bipolar pacing lead in the overlying cardiac vein for guidance during surgery. Surgical cryoablation was successful in 3 of the 4 patients. The fourth patient subsequently had successful endocardial catheter ablation. During a mean follow-up of 22 ± 16 months (range 4-42 months), all patients showed abolition of or marked reduction in symptomatic VA. However, 1 patient subsequently required percutaneous intervention to the left anterior descending coronary artery; another developed progressive left ventricular systolic dysfunction caused by nonischemic cardiomyopathy; and a third patient underwent permanent pacemaker implantation because of complete atrioventricular block after concomitant aortic valve replacement. CONCLUSION: Surgical cryoablation is an option for highly symptomatic drug-resistant VAs emanating from the LVOT region. Despite extensive preoperative mapping, the procedure is not effective for all patients, and coronary injury is a risk. CI - Copyright ??2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
keyword
Left ventricular outflow tract; Surgical cryoablation; Ventricular tachycardia; Ventricular tachycardia ablation
MESH
Adult, *Cryosurgery, Electrocardiography, Female, Humans, Male, Middle Aged, Tachycardia, Ventricular/*surgery
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