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• W2135710899 abstract "HomeCirculation: Arrhythmia and ElectrophysiologyVol. 4, No. 1Ablation of Ventricular Tachycardia in Chronic Chagasic Cardiomyopathy With Giant Basal Aneurysm Free AccessCase ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCase ReportPDF/EPUBAblation of Ventricular Tachycardia in Chronic Chagasic Cardiomyopathy With Giant Basal AneurysmCarto Sound, CT, and MRI Merge Bruno P. Valdigem, Fabio B.F.C.G. Pereira, Nilton J. Carneiro da Silva, Cristiano O. Dietrich, Ricardo Sobral, Fernando Lopes Nogueira, Roberto C. Berber, Fabricio Mallman, Ibraim M. Pinto, Gilberto Szarf, Claudio Cirenza and Angelo A.V. de Paola Bruno P. ValdigemBruno P. Valdigem From the Federal University of São Paulo, São Paulo, Brazil. Search for more papers by this author , Fabio B.F.C.G. PereiraFabio B.F.C.G. Pereira From the Federal University of São Paulo, São Paulo, Brazil. Search for more papers by this author , Nilton J. Carneiro da SilvaNilton J. Carneiro da Silva From the Federal University of São Paulo, São Paulo, Brazil. Search for more papers by this author , Cristiano O. DietrichCristiano O. Dietrich From the Federal University of São Paulo, São Paulo, Brazil. Search for more papers by this author , Ricardo SobralRicardo Sobral From the Federal University of São Paulo, São Paulo, Brazil. Search for more papers by this author , Fernando Lopes NogueiraFernando Lopes Nogueira From the Federal University of São Paulo, São Paulo, Brazil. Search for more papers by this author , Roberto C. BerberRoberto C. Berber From the Federal University of São Paulo, São Paulo, Brazil. Search for more papers by this author , Fabricio MallmanFabricio Mallman From the Federal University of São Paulo, São Paulo, Brazil. Search for more papers by this author , Ibraim M. PintoIbraim M. Pinto From the Federal University of São Paulo, São Paulo, Brazil. Search for more papers by this author , Gilberto SzarfGilberto Szarf From the Federal University of São Paulo, São Paulo, Brazil. Search for more papers by this author , Claudio CirenzaClaudio Cirenza From the Federal University of São Paulo, São Paulo, Brazil. Search for more papers by this author and Angelo A.V. de PaolaAngelo A.V. de Paola From the Federal University of São Paulo, São Paulo, Brazil. Search for more papers by this author Originally published1 Feb 2011https://doi.org/10.1161/CIRCEP.110.957571Circulation: Arrhythmia and Electrophysiology. 2011;4:112–114IntroductionChronic chagasic cardiomyopathy (CCC) is a parasitic disease that presents with life-threatening ventricular arrhythmias, dilated cardiomyopathy, or sudden death. Basal and posterior wall motion abnormalities and left apical aneurysms are common.We present a report of a patient with CCC, sustained ventricular tachycardia (Vt) refractory to amiodarone 400 mg/day and carvedilol 25 mg/day BID with a giant left basal aneurysm as visualized by CT scan and intracardiac echocardiogram 3D reconstruction(Carto Sound). The patient underwent preprocedural CT scan data acquisition with 64-slice MDCT scanner Aquilion (Toshiba, Tochigi, Japan), and the images were used for 3D reconstruction with Cartomerge (Biosense Webster, Inc., Diamond Bar, CA). Images acquired using cardiac MRI confirmed the size and shape of the aneurysm. No significant scar was observed in other areas of the LV. Images of the CT Scan and Carto Sound acquired with Soundstar catheter and electroanatomic mapping were merged and ablation was performed with a 3.5-mm cooled-tip catheter (Figures 1 and 2). Programmed right ventricular stimulation with 2 extra stimuli induced sustained Vt. Endocardial and epicardial mapping was performed in sinus rhythm (voltage mapping) and during Vt (activation mapping). During epicardial mapping in sinus rhythm, surface voltage exceeded 1.5 mV, and during Vt no evidence of epicardial circuit was found. Intracardiac echocardiography with image integration was helpful for catheter tip location (Figure 3) and ablation of the aneurysm border. Mid-diastolic potentials (Figure 4, left) and concealed entrainment indicated an endocardial circuit isthmus located between the aneurysm proximal border and the mitral valve. When the endocardial circuit was localized, radiofrequency energy was delivered interrupting the Vt. Late potentials could be seen on that site, and they were also targeted (Figure 4, right). An implantable cardioverter-defibrillator was implanted and the patient remained free of the clinical Vt.Download figureDownload PowerPointFigure 1. Comparison of CT scan and ICE-3D reconstructed images. Two different maps were used to get a better definition of the aorta and cusps and the LV epicardium. Left, The ascending aorta and its relation to the endocardial LV voltage map are visible. Right, The anatomy of the three cusps. Red indicates areas of amplitude <0.52 mV; purple, amplitude >1.51 mV (same voltage scale as Figure 2).Download figureDownload PowerPointFigure 2. Integration of images was performed using the coronary cusps and coronary ostia as visualized by ICE, the endocardial voltage EA map, and the CT scan data. Red indicates areas of amplitude <0.52 mV; purple, amplitude >1.51 mV.Download figureDownload PowerPointFigure 3. Images were acquired in real time during ablation. Left, A view with only ICE. Right, An LV endocardial voltage map is combined with CT scan data reconstruction. The catheter tip is near the mitral valve, and the aneurysm borders are clearly visible, as well as the distance between the proximal and the distal borders of the aneurysm. Red indicates areas of amplitude <0.52 mV; purple, amplitude >1.51 mV.Download figureDownload PowerPointFigure 4. Left, Clinical Vt induced and nid-diastolic potentials. Middle, ICE-3D endocardial LV activation map in sinus rhythm with successful ablation target highlighted. Right, Vt termination during ablation in a site with late fragmented potentials. The dashed red circle indicates the catheter tip position during the events described in the left and right panels (mid-diastolic potentials, Vt termination during ablation, and late potentials).Intracardiac echocardiogram integration with electroanatomical mapping is a novel tool for image integration and may improve anatomy visualization for catheter ablation of cardiac arrhythmias.1–3DisclosuresNone.FootnotesThe online-only Data Supplement is available at http://circep.ahajournals.org/cgi/content/full/CIRCEP.110.957571/DC1.Correspondence to Bruno Pereira Valdigem, 715 Rua Napoleão de Barros, Setor de Hemodinâmica, Vila Clementino, São Paulo, Brazil. E-mail valdigem@gmail.comReferences1. Ferguson JD, Helms A, Mangrum JM, Mahapatra S, Mason P, Bilchick K, McDaniel G, Wiggins D, DiMarco JP. Catheter ablation of atrial fibrillation without fluoroscopy using intracardiac echocardiography and electroanatomic mapping. Circ Arrhythm Electrophysiol. 2009; 2:611–619.LinkGoogle Scholar2. den Uijl DW, Tops LF, Tolosana JM, Schuijf JD, Trines SA, Zeppenfeld K, Bax JJ, Schalij MJ. Real-time integration of intracardiac echocardiography and multislice computed tomography to guide radiofrequency catheter ablation for atrial fibrillation. Heart Rhythm. 2008; 5:1403–1410.CrossrefMedlineGoogle Scholar3. Tian J, Smith MF, Jeudy J, Dickfeld T. Multimodality fusion imaging using delayed-enhanced cardiac magnetic resonance imaging, computed tomography, positron emission tomography, and real-time intracardiac echocardiography to guide ventricular tachycardia ablation in implantable cardioverter-defibrillator patients. Heart Rhythm. 2009; 6:825–828.CrossrefMedlineGoogle Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsCited By Restrepo A and Dickfeld T (2020) Perioperative Imaging to Guide Epicardial Mapping and Ablation, Cardiac Electrophysiology Clinics, 10.1016/j.ccep.2020.06.001, 12:3, (281-293), Online publication date: 1-Sep-2020. Chrispin J and Nazarian S (2019) Magnetic Resonance Imaging Mapping of Ventricular Tachycardia in Patients with Different Cardiomyopathies (Arrhythmogenic Right Ventricular Dysplasia, Amyloidosis, etc.) Cardiac Mapping, 10.1002/9781119152637.ch77, (970-977) Inaba O, Nitta J, Kuroda S, Sekigawa M, Suzuki M, Inamura Y, Satoh A, Isobe M and Hirao K (2017) A new mapping method to estimate exit sites of ventricular arrhythmias using intracardiac echocardiography and M-mode for catheter ablation, Journal of Arrhythmia, 10.1016/j.joa.2017.05.006, 33:5, (440-446), Online publication date: 1-Oct-2017. Grillo T, Athayde G, Belfort A, Miranda R, Beaton A and Nascimento B (2015) Mitral Subvalvular Aneurysm in a Patient with Chagas Disease and Recurrent Episodes of Ventricular Tachycardia, Case Reports in Cardiology, 10.1155/2015/213104, 2015, (1-5), . Ling Z, Hari A and Tandri H (2014) VT ablation: New Developments and Approaches, Current Treatment Options in Cardiovascular Medicine, 10.1007/s11936-014-0297-2, 16:4, Online publication date: 1-Apr-2014. Stevenson W and Asirvatham S (2013) Fundamental Concepts in Electrophysiology in Cases and Reviews, Circulation: Arrhythmia and Electrophysiology, 6:6, (e95-e100), Online publication date: 1-Dec-2013. Bestetti R and Cardinalli-Neto A (2014) Device therapy in Chagas disease heart failure, Expert Review of Cardiovascular Therapy, 10.1586/erc.12.115, 10:10, (1307-1317), Online publication date: 1-Oct-2012. Yamada T and Kay G (2012) Optimal ablation strategies for different types of ventricular tachycardias, Nature Reviews Cardiology, 10.1038/nrcardio.2012.74, 9:9, (512-525), Online publication date: 1-Sep-2012. February 2011Vol 4, Issue 1 Advertisement Article InformationMetrics © 2011 American Heart Association, Inc.https://doi.org/10.1161/CIRCEP.110.957571PMID: 21325215 Manuscript receivedJuly 14, 2010Manuscript acceptedNovember 8, 2010Originally publishedFebruary 1, 2011 PDF download Advertisement SubjectsArrhythmiasCatheter Ablation and Implantable Cardioverter-DefibrillatorComputerized Tomography (CT)ElectrophysiologyImaging" @default.
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