TY - JOUR
T1 - Acute and Long-Term Scar Characterization of Venous Ethanol Ablation in the Left Ventricular Summit
AU - Fuentes Rojas, Stephanie C.
AU - Malahfji, Maan
AU - Tavares, Liliana
AU - Patel, Apoor
AU - Schurmann, Paul A.
AU - Dave, Amish S.
AU - Tapias, Carlos
AU - Rodríguez, Diego
AU - Sáenz, Luis Carlos
AU - Korolev, Sergey
AU - Papiashvili, Giorgi
AU - Peichl, Petr
AU - Kautzner, Josef
AU - Blaszyk, Krzysztof
AU - Malaczynska-Rajpold, Katarzyna
AU - Chen, Tiffany
AU - Santangeli, Pasquale
AU - Shah, Dipan J.
AU - Valderrábano, Miguel
N1 - Funding Information:
The authors thank Adelina Ramirez, Holly Zapalac, and Christina Schramm.
Publisher Copyright:
© 2023 American College of Cardiology Foundation
PY - 2023/1
Y1 - 2023/1
N2 - Background: Venous ethanol ablation (VEA) can be effective for ventricular arrhythmias from the left ventricular summit (LVS); however, there are concerns about excessive ablation by VEA. Objectives: The purpose of this study was to delineate and quantify the location, extent, and evolution of ablated tissue after VEA as an intramural ablation technique in the LVS. Methods: VEA was performed in 59 patients with LVS ventricular arrhythmias. Targeted intramural veins were selected by electrograms from a 2F octapolar catheter or by guide-wire unipolar signals. Median ethanol delivered was 4 mL (IQR: 4-7 mL). Ablated areas were estimated intraprocedurally as increased echogenicity on intracardiac echocardiography (ICE) and incorporated into 3-dimensional maps. In 44 patients, late gadolinium enhancement cardiac magnetic resonance (CMR) imaged VEA scar and its evolution. Results: ICE-demonstrated increased intramural echogenicity (median volume of 2 mL; IQR: 1.7-4.3) at the targeted region of the 3-dimensional maps. Post-ethanol CMR showed intramural scar of 2.5 mL (IQR: 2.1-3.5 mL). Early (within 48 hours after VEA) CMR showed microvascular obstruction (MVO) in 30 of 31 patients. Follow-up CMR after a median of 51 (IQR: 41-170) days showed evolution of MVO to scar. ICE echogenicity and CMR scar volumes correlated with each other and with ethanol volume. Ventricular function and interventricular septum remained intact. Conclusions: VEA leads to intramural ablation that can be tracked intraprocedurally by ICE and creates regions of MVO that are chronically replaced by myocardial scar. VEA scar volume does not compromise septal integrity or ventricular function.
AB - Background: Venous ethanol ablation (VEA) can be effective for ventricular arrhythmias from the left ventricular summit (LVS); however, there are concerns about excessive ablation by VEA. Objectives: The purpose of this study was to delineate and quantify the location, extent, and evolution of ablated tissue after VEA as an intramural ablation technique in the LVS. Methods: VEA was performed in 59 patients with LVS ventricular arrhythmias. Targeted intramural veins were selected by electrograms from a 2F octapolar catheter or by guide-wire unipolar signals. Median ethanol delivered was 4 mL (IQR: 4-7 mL). Ablated areas were estimated intraprocedurally as increased echogenicity on intracardiac echocardiography (ICE) and incorporated into 3-dimensional maps. In 44 patients, late gadolinium enhancement cardiac magnetic resonance (CMR) imaged VEA scar and its evolution. Results: ICE-demonstrated increased intramural echogenicity (median volume of 2 mL; IQR: 1.7-4.3) at the targeted region of the 3-dimensional maps. Post-ethanol CMR showed intramural scar of 2.5 mL (IQR: 2.1-3.5 mL). Early (within 48 hours after VEA) CMR showed microvascular obstruction (MVO) in 30 of 31 patients. Follow-up CMR after a median of 51 (IQR: 41-170) days showed evolution of MVO to scar. ICE echogenicity and CMR scar volumes correlated with each other and with ethanol volume. Ventricular function and interventricular septum remained intact. Conclusions: VEA leads to intramural ablation that can be tracked intraprocedurally by ICE and creates regions of MVO that are chronically replaced by myocardial scar. VEA scar volume does not compromise septal integrity or ventricular function.
KW - ablation
KW - cardiac magnetic resonance
KW - ethanol
KW - ventricular arrhythmias
KW - Contrast Media
KW - Humans
KW - Catheter Ablation/methods
KW - Ventricular Septum
KW - Gadolinium
KW - Arrhythmias, Cardiac/surgery
KW - Cicatrix
KW - Tachycardia, Ventricular/surgery
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U2 - 10.1016/j.jacep.2022.08.035
DO - 10.1016/j.jacep.2022.08.035
M3 - Article
C2 - 37166222
AN - SCOPUS:85146090986
SN - 2405-500X
VL - 9
SP - 28
EP - 39
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 1
ER -