Heart Failure Reviews

, Volume 16, Issue 5, pp 467–476

Assessing patients for catheter ablation during hospitalization for acute heart failure

Article

Abstract

Heart rhythm problems are common among patients who are hospitalized with acute heart failure (HF). Although it is often difficult to determine whether a tachyarrhythmia is the major contributor to an acute HF decompensation or merely a consequence of the decompensation, both issues usually need to be addressed. There is also a subset of patients with HF who have a tachycardia-induced cardiomyopathy (TIC), where the sole cause of the ventricular dysfunction is the heart rhythm problem. In most cases, the management of a tachyarrhythmia in a patient with acute HF is not significantly different than the management of a heart rhythm problem in any patient, but there are several special clinical scenarios and important considerations. These considerations include the time urgency for an intervention, the usual need to be more aggressive and definitive, the need to stabilize a patient to allow for a heart rhythm intervention, such as catheter ablation to be performed safely, and the limitations of antiarrhythmic drugs in patients with ventricular dysfunction. Catheter ablation is a highly effective treatment option for many patients with supraventricular or ventricular tachycardias who are hospitalized with HF. This review will discuss the different types of tachyarrhythmias that can be associated with acute HF and are amenable to catheter ablation, and the assessment that needs to take place in potentially eligible patients to determine when catheter ablation is appropriate.

Keywords

Heart failure Catheter ablation Atrial fibrillation Ventricular tachycardia 

References

  1. 1.
    Nerheim P, Birger-Botkin S, Piracha L, Olshansky B (2004) Heart failure and sudden death in patients with tachycardia-induced cardiomyopathy and recurrent tachycardia. Circulation 110:247–252PubMedCrossRefGoogle Scholar
  2. 2.
    Knight BP, Zivin A, Souza J, Goyal R, Man KC, Strickberger SA, Morady F (1998) Use of adenosine in patients hospitalized in a university medical center. Am J Med 105:275–280PubMedCrossRefGoogle Scholar
  3. 3.
    Knight BP, Ebinger M, Oral H, Kim MH, Sticherling C, Flemming M, Pelosi F, Michaud GF, Strickberger SA, Morady F (2000) Diagnostic value of tachycardia features and pacing maneuvers during paroxysmal supraventricular tachycardia. J Am Coll Cardiol 36:574–582PubMedCrossRefGoogle Scholar
  4. 4.
    Cruz FE, Cheriex EC, Smeets JL et al (1990) Reversibility of tachycardia-induced cardiomyopathy after cure of incessant supraventricular tachycardia. J Am Coll Cardiol 16:739–744PubMedCrossRefGoogle Scholar
  5. 5.
    Tomaske M, Janousek J, Razek V, Gebauer RA, Tomek V, Hindricks G, Knirsch W, Bauersfeld (2008) Adverse effects of Wolff–Parkinson–White syndrome with right septal or posteroseptal accessory pathways on cardiac function. Europace 10:181–189Google Scholar
  6. 6.
    Gelb B, Garson A (1990) Noninvasive discrimination of right atrial ectopic tachycardia from sinus tachycardia in “dilated cardiomyopathy”. Am Heart J 120:886–891PubMedCrossRefGoogle Scholar
  7. 7.
    Mohamed U, Skanes AC, Gula LJ, Leong-Sit P, Krahn AD, Yee R et al (2007) A novel pacing maneuver to localize focal atrial tachycardia. J Cradiovasc Electrophysiol 18:1–6CrossRefGoogle Scholar
  8. 8.
    Knight BP, Michaud GF, Strickberger SA, Morady F (1999) Electrocardiographic differentiation of atrial flutter from atrial fibrillation by Physicians. J Electrocardiography 32:315–319CrossRefGoogle Scholar
  9. 9.
    Blomström-Lundqvist C, Scheinman MM, Aliot EM, Alpert JS, Calkins H, Camm AJ, Campbell WB, Haines DE, Kuck KH, Lerman BB, Miller DD, Shaeffer CW, Stevenson WG, Tomaselli GF (2003) ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias. American College of Cardiology Web Site. Available at: http://www.acc.org/clinical/guidelines/arrhythmias/sva_index.pdf
  10. 10.
    Anter E, Jessup M, Callans DJ (2009) Atrial fibrillation and heart failure: treatment considerations for a dual epidemic. Circulation 119:2516–2525PubMedCrossRefGoogle Scholar
  11. 11.
    Crijns HJ, Van den Berg MP, Van Gelder IC, Van Veldhuisen DJ (1997) Management of atrial fibrillation in the setting of heart failure. European Heart J 18:C45–C49Google Scholar
  12. 12.
    Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Le Heuzey JY, Kay GN, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann S, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Halperin JL, Hunt SA, Nishimura R, Ornato JP, Page RL, Riegel B, Priori SG, Blanc JJ, Budaj A, Camm AJ, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL, American College of Cardiology/American Heart Association Task Force on Practice Guidelines; European Society of Cardiology Committee for Practice Guidelines, European Heart Rhythm Association; Heart Rhythm Society (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114:e257–e354Google Scholar
  13. 13.
    Roy D, Talajic M, Nattel S, Wyse DG, Dorian P, Lee KL, Bourassa MG, Arnold JM, Buxton AE, Camm AJ, Connolly SJ, Dubuc M, Ducharme A, Guerra PG, Hohnloser SH, Lambert J, Le Heuzey JY, O’Hara G, Pedersen OD, Rouleau JL, Singh BN, Stevenson LW, Stevenson WG, Thibault B, Waldo AL, Atrial Fibrillation and Congestive Heart Failure Investigators (2008) Rhythm control versus rate control for atrial fibrillation and heart failure. N Engl J Med 19(358):2667–2677CrossRefGoogle Scholar
  14. 14.
    Doshi RN, Daoud EG, Fellows C et al (2005) Left ventricular-based cardiac stimulation post AV nodal ablation evaluation (the PAVE study). J Cardiovasc Electrophysiol 16:1160–1165PubMedCrossRefGoogle Scholar
  15. 15.
    Haissaguerre M, Jais P, Shah DC et al (1998) Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 339:659–666PubMedCrossRefGoogle Scholar
  16. 16.
    Oral H, Knight BP, Tada H, Ozaydin M, Chugh A, Hassan S, Scharf C, Lai SW, Greenstein R, Pelosi F Jr, Strickberger SA, Morady F (2002) Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation 105:1077–1081PubMedCrossRefGoogle Scholar
  17. 17.
    Haissaguerre M, Hocini M, Sanders P et al (2005) Catheter ablation of long-standing persistent atrial fibrillation: clinical outcome and mechanisms of subsequent arrhythmias. J Cardiovasc Electrophysiol 16:1138–1147PubMedCrossRefGoogle Scholar
  18. 18.
    Nademanee K, McKenzie J, Kosar E et al (2004) A new approach for catheter ablation of atrial fibrillation: Mapping of the electrophysiologic substrate. J Am Coll Cardiol 43:2044–2053PubMedCrossRefGoogle Scholar
  19. 19.
    Calkins H, Brugada J, Packer DL et al. (2007) HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task force on Catheter and Surgical Ablation of Atrial Fibrillation developed in partnership with the European Heart Rhythm Association (EHRA) and the Euorpean Cardiac arrhythmia Society (ECAS) in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of thoracic Surgeions (STS). Endorsed and approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeions, and the Heart Rhythm Society. Europace 9:335–379Google Scholar
  20. 20.
    Khan MN, Jais P, Cummings J et al (2008) Pulmonary-vein isolation for atrial fibrillation in patients with heart failure. N Engl J Med 359:1778–1785PubMedCrossRefGoogle Scholar
  21. 21.
    Jackson E, Bellenger N, Seddon M et al (2007) Ischaemic and non-ischaemic cardiomyopathies–cardiac MRI appearances with delayed enhancement. Clin Radiol 62(5):395–403PubMedCrossRefGoogle Scholar
  22. 22.
    Sosa E, Scanavacca M, d’Avila A et al (1996) A new technique to perform epicardial mapping in the electrophysiology laboratory. J Cardiovasc Electrophysiol 7(6):531–536PubMedCrossRefGoogle Scholar
  23. 23.
    de Bakker JM, van Capelle FJ, Janse MJ et al (1988) Reentry as a cause of ventricular tachycardia in patients with chronic ischemic heart disease: electrophysiologic and anatomic correlation. Circulation 77(3):589–606PubMedCrossRefGoogle Scholar
  24. 24.
    Soejima K, Stevenson W, Sapp J et al (2004) Endocardial and epicardial radiofrequency ablation of ventricular. J Am Coll Cardiol 43(10):1834–1842PubMedCrossRefGoogle Scholar
  25. 25.
    Reddy VY, Reynolds MR, Neuzil P et al (2007) Prophylactic catheter ablation for the prevention of defibrillator therapy. N Engl J Med 357(26):2657–2665PubMedCrossRefGoogle Scholar
  26. 26.
    Kuck KH, Schaumann A, Eckardt L et al (2010) Catheter ablation of stable ventricular tachycardia before defibrillator implantation in patients with coronary heart disease (VTACH): a multicentre randomised controlled trial. Lancet 375(9708):31–40PubMedCrossRefGoogle Scholar
  27. 27.
    Marchlinski FE, Callans DJ, Gottlieb CD et al (2000) Linear ablation lesions for control of unmappable ventricular tachycardia in patients with ischemic and nonischemic cardiomyopathy. Circulation 101(11):1288–1296PubMedGoogle Scholar
  28. 28.
    Stevenson WG, Wilber DJ, Natale A et al (2008) Irrigated radiofrequency catheter ablation guided by electroanatomic mapping for recurrent ventricular tachycardia after myocardial infarction: the multicenter thermocool ventricular tachycardia ablation trial. Circulation 118(25):2773–2782PubMedCrossRefGoogle Scholar
  29. 29.
    Khan HH, Maisel WH, Ho C et al (2002) Effect of radiofrequency catheter ablation of ventricular tachycardia on left ventricular function in patients with prior myocardial infarction. J Interv Card Electrophysiol 7(3):243–247PubMedCrossRefGoogle Scholar
  30. 30.
    Friedman PA, Munger TM, Torres N et al (2007) Percutaneous endocardial and epicardial ablation of hypotensive ventricular tachycardia with percutaneous left ventricular assist in the electrophysiology laboratory. J Cardiovasc Electrophysiol 18(1):106–109PubMedCrossRefGoogle Scholar
  31. 31.
    Nademanee K, Taylor R, Bailey WE et al (2000) Treating electrical storm : sympathetic blockade versus advanced cardiac life support-guided therapy. Circulation 102(7):742–747PubMedGoogle Scholar
  32. 32.
    Mahajan A, Moore J, Cesario DA et al (2005) Use of thoracic epidural anesthesia for management of electrical storm: a case report. Heart Rhythm 2(12):1359–1362PubMedCrossRefGoogle Scholar
  33. 33.
    Carbucicchio C, Santamaria M, Trevisi N et al (2008) Catheter ablation for the treatment of electrical storm in patients with implantable cardioverter-defibrillators: short- and long-term outcomes in a prospective single-center study. Circulation 117(4):462–469PubMedCrossRefGoogle Scholar
  34. 34.
    Sinha AM, Schmidt M, Marschang H et al (2009) Role of left ventricular scar and Purkinje-like potentials during mapping and ablation of ventricular fibrillation in dilated cardiomyopathy. Pacing Clin Electrophysiol 32(3):286–290PubMedCrossRefGoogle Scholar
  35. 35.
    Marrouche NF, Verma A, Wazni O et al (2004) Mode of initiation and ablation of ventricular fibrillation storms in patients with ischemic cardiomyopathy. J Am Coll Cardiol 43(9):1715–1720PubMedCrossRefGoogle Scholar
  36. 36.
    Duffee DF, Shen WK, Smith HC (1998) Suppression of frequent premature ventricular contractions and improvement of left ventricular function in patients with presumed idiopathic dilated cardiomyopathy. Mayo Clin Proc 73(5):430–433PubMedCrossRefGoogle Scholar
  37. 37.
    Yarlagadda RK, Iwai S, Stein KM et al (2005) Reversal of cardiomyopathy in patients with repetitive monomorphic ventricular ectopy originating from the right ventricular outflow tract. Circulation 112(8):1092–1097PubMedCrossRefGoogle Scholar
  38. 38.
    Badhwar N, Scheinman MM (2007) Idiopathic ventricular tachycardia: diagnosis and management. Curr Probl Cardiol 32(1):7–43PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Internal Medicine, Division of CardiologyNorthwestern UniversityChicagoUSA

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