Bipolar radiofrequency ablation in the treatment of left ventricular aneurysm with ventricular arrhythmias guided by CARTO mapping system: A randomized controlled trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DAI Longsheng , LIU Changcheng , GAO Mingxin , LI Qin , YU Yang ,  GU Chengxiong

Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P.R.China;

Corresponding author：

GU Chengxiong, Email: anzhengu@sina.com

Keywords：

Ventricular aneurysm; ventricular arrhythmias; bipolar radiofrequency ablation; coronary artery bypass grafting

DOI：

10.7507/1007-4848.201612015

Video：

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Objective To evaluate the efficacy and clinical significance of bipolar radiofrequency ablation in the treatment of left ventricular aneurysm with ventricular arrhythmias guided by CARTO mapping system. Methods From September 2009 to December 2015, 56 patients with ventricular aneurysm following myocardial infarction were enrolled. All patients suffered different levels of angina pectoris symptoms evaluated by Holter (the frequencies of ventricular arrhythmias more than 3 000 per day). They were divided into two groups according to random ballot and preoperative communication with patients' family members: a bipolar radiofrequency ablation group (n=28, 20 males, 8 females, mean age of 61.21±1.28 years) receiving off-pump coronary artery bypass grafting (OPCABG), ventricular aneurysm surgery combined with bipolar radiofrequency ablation, and a non-bipolar radiofrequency ablation group (n=28, 22 males, 6 females, mean age of 57.46±1.30 years) receiving OPCABG and single ventricular aneurysm surgery. The grade of cardiac function and ventricular arrhythmia was compared between the two groups during pre-operation, discharge and follow-up. Results All patients were discharged successfully. There was no in-hospital death in both two groups. One patient in the non-radiofrequency group had cerebral infarction. All patients were re-checked with Holter before discharge and the frequency of ventricular arrhythmias significantly decreased compared to that of pre-operation in both groups, and was more significant in bipolar radiofrequency ablation group (1 197.00±248.20 times/24 h vs. 1 961.00±232.90 times/24 h, P<0.05). There was significant difference in duration of mechanical ventilation and ICU stay between the two groups (P<0.05). The left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) significantly improved (P<0.05) after operation in both groups. Conclusion The clinical efficacy of bipolar radiofrequency ablation in the treatment of ventricular aneurysm with ventricular arrhythmia guided by CARTO mapping is safe and effective, but its long-term outcomes still need further follow-up.

Citation： DAI Longsheng, LIU Changcheng, GAO Mingxin, LI Qin, YU Yang, GU Chengxiong. Bipolar radiofrequency ablation in the treatment of left ventricular aneurysm with ventricular arrhythmias guided by CARTO mapping system: A randomized controlled trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(9): 677-682. doi: 10.7507/1007-4848.201612015 Copy

1.	Cavallé-Garrido T, Cloutier A, Harder J, et al. Evolution of fetal ventricular aneurysms and diverticula of the heart: an echocardiographic study. Am J Perinatol, 1997, 14(7): 393-400.
2.	Yu Y, Gao MX, Li HT, et al. Epicardial radiofrequency ablation for left ventricular aneurysm related ventricular arrhythmias during off-pump coronary artery bypass surgery. Chin Med J, 2012, 125(21): 3836-3839.
3.	Kothari J, Hinduja M, Baria K, et al. Surgical repair of multiple congenital left ventricular aneurysms with rupture into left atrium. J Card Surg, 2016, 31(9): 601-603.
4.	李菊香, 洪葵. 非结构性心脏病恶性室性心律失常射频消融治疗现状. 中国心脏起搏与心电生理杂志, 2010, 24(3): 194-195.
5.	Solinas M, Bevilacqua S, Karimov JH, et al. A left atrial ablation with bipolar irrigated radio-frequency for atrial fibrillation during rain-imally invasive mitral valve surgery. Eur J Cardiothorac Surg, 2010, 37(4): 965-966.
6.	Yang H, Zhang FF, Peng XH, et al. Efficacy of medication directed by home—monitoring cardiac resynchronization therapy in chronic heart failure patients. Chin Med Sci J, 2014, 29(1): 61-62.
7.	Santamaria M, Cireddu M, Riva S, et al. Radiofrequency catheter ablation guided by noncontact mapping of ventricular tachycardia originating from an idiopathic left ventricular aneurysm. J Interv Card Electrophysiol, 2007, 19(1): 49-53.
8.	Cooley DA, Collins HA, Morris GC Jr, et al. Ventricular aneurysm after myocardial infarction: surgical excision with use of temporary cardiopulmonary bypass. J Am Med Assoc, 1958, 167(5): 557-560.
9.	Jatene AD. Left ventricular aneurysmectomy. Resection or reconstruction. J Thorac Cardiovasc Surg, 1985, 89(3): 321-331.
10.	穆军升, 张健群, 周帆, 等. 左心室室壁瘤所致心律失常的 6 例外科治疗. 心肺血管病杂志, 2013, 32(2): 190-193.
11.	Picoli C, Nouvel V, Aubry F, et al. Human connexin channel specificity of classical and new gap junction inhibitors. J Biomol Screen, 2012, 17(10): 1339-1347.
12.	Rickelt S, Pieperhoff S. Mutations with pathogenic potential in proteins located in or at the composite junctions of the intercalated disk connecting mammalian cardiomyocytes: a reference thesaurus for atrhythmogenic cardiomyopathies and for Naxos and Carvajal disease. Cell Tissue Res, 2012, 348(2): 325-333.
13.	Makinoshima H, Ishii G, Kojima M, et al. PTPRZl regulates calmodulin phosphorylation and tumor progression in small-cell lung carcinoma. BMC Cancer, 2012, 12(1): 537.
14.	Btaszyk K, Wasniewski M, Greek S. Contribution of atrioventricu1ar node inputs on orthodromic atrioventricular reentrant tachycardia cycle length. Kardiol Pol, 2010, 68(2): 232-236.
15.	Mamindy-Pajany Y, Libralato G, Romeo M, et al. Ecotoxicological evaluation of Mediterranean dredged sediment ports based on elutriates with oyster embryotoxicity tests after composting process. Water Res, 2010, 44(6): 1986-1994.
16.	Damiano RJ, Badhwar V, Acker MA, et al. The CURE-AF trial: a prospective, multicenter trial of irrigated radiofrequency ablation for the treatment of persistent atrial fibrillation during concomitant cardiac surgery. Heart Rhythm, 2014, 11(1): 39-45.
17.	Yu Y, Gao MX, Wang C, et al. Bipolar radiofrequency ablation for left ventricular aneurysm-related ventricular arrhythmia. J Thorac Cardiovasc Surg, 2012, 144(4): e101-e102.
18.	Samore NA, Imran Majeed SM, Kayani AM, et al. Outcome of radiofrequency catheter ablation as a non-pharmacological therapy for idiopathic ventricular tachycardia. JCPSP, 2009, 19(9): 548-552.
19.	Ito S, Kamegai A, Murakami Y, et al. Persistent electrical scar in the atrium evaluated on voltage mapping with a CARTO system in suspected acute myocarditis. Circ J, 2012, 76(12): 2895-2897.
20.	Yu Y, Gao MX, Gu CX. Epicardial unipolar radiofrequency ablation for left ventricular aneurysm related ventricular arrhythmia. J Cardiothorac Surg, 2013, 8: 124.

1. Cavallé-Garrido T, Cloutier A, Harder J, et al. Evolution of fetal ventricular aneurysms and diverticula of the heart: an echocardiographic study. Am J Perinatol, 1997, 14(7): 393-400.
2. Yu Y, Gao MX, Li HT, et al. Epicardial radiofrequency ablation for left ventricular aneurysm related ventricular arrhythmias during off-pump coronary artery bypass surgery. Chin Med J, 2012, 125(21): 3836-3839.
3. Kothari J, Hinduja M, Baria K, et al. Surgical repair of multiple congenital left ventricular aneurysms with rupture into left atrium. J Card Surg, 2016, 31(9): 601-603.
4. 李菊香, 洪葵. 非结构性心脏病恶性室性心律失常射频消融治疗现状. 中国心脏起搏与心电生理杂志, 2010, 24(3): 194-195.
5. Solinas M, Bevilacqua S, Karimov JH, et al. A left atrial ablation with bipolar irrigated radio-frequency for atrial fibrillation during rain-imally invasive mitral valve surgery. Eur J Cardiothorac Surg, 2010, 37(4): 965-966.
6. Yang H, Zhang FF, Peng XH, et al. Efficacy of medication directed by home—monitoring cardiac resynchronization therapy in chronic heart failure patients. Chin Med Sci J, 2014, 29(1): 61-62.
7. Santamaria M, Cireddu M, Riva S, et al. Radiofrequency catheter ablation guided by noncontact mapping of ventricular tachycardia originating from an idiopathic left ventricular aneurysm. J Interv Card Electrophysiol, 2007, 19(1): 49-53.
8. Cooley DA, Collins HA, Morris GC Jr, et al. Ventricular aneurysm after myocardial infarction: surgical excision with use of temporary cardiopulmonary bypass. J Am Med Assoc, 1958, 167(5): 557-560.
9. Jatene AD. Left ventricular aneurysmectomy. Resection or reconstruction. J Thorac Cardiovasc Surg, 1985, 89(3): 321-331.
10. 穆军升, 张健群, 周帆, 等. 左心室室壁瘤所致心律失常的 6 例外科治疗. 心肺血管病杂志, 2013, 32(2): 190-193.
11. Picoli C, Nouvel V, Aubry F, et al. Human connexin channel specificity of classical and new gap junction inhibitors. J Biomol Screen, 2012, 17(10): 1339-1347.
12. Rickelt S, Pieperhoff S. Mutations with pathogenic potential in proteins located in or at the composite junctions of the intercalated disk connecting mammalian cardiomyocytes: a reference thesaurus for atrhythmogenic cardiomyopathies and for Naxos and Carvajal disease. Cell Tissue Res, 2012, 348(2): 325-333.
13. Makinoshima H, Ishii G, Kojima M, et al. PTPRZl regulates calmodulin phosphorylation and tumor progression in small-cell lung carcinoma. BMC Cancer, 2012, 12(1): 537.
14. Btaszyk K, Wasniewski M, Greek S. Contribution of atrioventricu1ar node inputs on orthodromic atrioventricular reentrant tachycardia cycle length. Kardiol Pol, 2010, 68(2): 232-236.
15. Mamindy-Pajany Y, Libralato G, Romeo M, et al. Ecotoxicological evaluation of Mediterranean dredged sediment ports based on elutriates with oyster embryotoxicity tests after composting process. Water Res, 2010, 44(6): 1986-1994.
16. Damiano RJ, Badhwar V, Acker MA, et al. The CURE-AF trial: a prospective, multicenter trial of irrigated radiofrequency ablation for the treatment of persistent atrial fibrillation during concomitant cardiac surgery. Heart Rhythm, 2014, 11(1): 39-45.
17. Yu Y, Gao MX, Wang C, et al. Bipolar radiofrequency ablation for left ventricular aneurysm-related ventricular arrhythmia. J Thorac Cardiovasc Surg, 2012, 144(4): e101-e102.
18. Samore NA, Imran Majeed SM, Kayani AM, et al. Outcome of radiofrequency catheter ablation as a non-pharmacological therapy for idiopathic ventricular tachycardia. JCPSP, 2009, 19(9): 548-552.
19. Ito S, Kamegai A, Murakami Y, et al. Persistent electrical scar in the atrium evaluated on voltage mapping with a CARTO system in suspected acute myocarditis. Circ J, 2012, 76(12): 2895-2897.
20. Yu Y, Gao MX, Gu CX. Epicardial unipolar radiofrequency ablation for left ventricular aneurysm related ventricular arrhythmia. J Cardiothorac Surg, 2013, 8: 124.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Bipolar radiofrequency ablation in the treatment of left ventricular aneurysm with ventricular arrhythmias guided by CARTO mapping system: A randomized controlled trial

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