Integrated Care for Management of Ventricular Arrhythmias Can a Specialized Unit and Catheter Ablation Improve Mortality?

UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095. .
Circulation (Impact Factor: 14.43). 04/2013; 127(13):1354-6. DOI: 10.1161/CIRCULATIONAHA.113.001775
Source: PubMed
2 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Radiofrequency ablation may prevent or treat atrial and ventricular arrhythmias. Since some of these arrhythmias are associated with sudden cardiac death, it has been hypothesized that ablation may prevent sudden death in certain cases. We performed a literature search to better understand under which circumstances ablation may prevent sudden death and found little randomized data demonstrating the long-term effects of ablation. Current literature shows that ablation clearly prevents symptoms of arrhythmia and may reduce the incidence of sudden cardiac death in select patients, although data does not indicate improved mortality. Ongoing clinical trials are needed to better define the role of ablation in preventing sudden cardiac death.
    Methodist DeBakey cardiovascular journal 04/2015; Vol. 11(No. 2):121-128. DOI:10.14797/mdcj-11-2-121
  • [Show abstract] [Hide abstract]
    ABSTRACT: Cardiac electroanatomical mapping (EAM) to locate myocardial scar substrate during ventricular tachycardia (VT) ablation therapy is currently faced with a major limitation. The presence of epicardial fat leads to false-positive low-voltage maps that may interpreted as myocardial scar. Pre-procedural cardiac magnetic resonance (CMR) imaging can produce images of the heart in which both cardiac geometry and epicardial fat are particularly conspicuous. The goal of the present work is to build CMR based geometric models composed of a shell of the cardiac anatomy and epicardial fat. Herein, we first defined a black-blood imaging protocol that is feasible in patients with implanted devices. Then a semi-automated image segmentation method was developed and applied to extract ventricular surface anatomy and epicardial fat maps from which three-dimensional surfaces were built. The results suggest that deriving maps of epicardial fat from MRI data is feasible, accurate when compared to expert observers, and suitable for integration in a clinical catheter-based ablation procedure.