Radiofrequency Ablation to Prevent Sudden Cardiac Death

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.

Keywords: radiofrequency ablation; sudden cardiac death.

M. Atoui, M.D.

Figure 1.

Twelve-lead electrocardiogram during radiofrequency ablation at the right Purkinje system. The start of ablation (arrow) typically resulted in ventricular tachycardia followed by sinus rhythm, as shown in this example. Reprinted from Journal of the American College of Cardiology, 54(6), Knecht S, Sacher F, Wright M, Hocini M, Nogami A, Arentz T, et al., Long term follow up of idiopathic ventricular fibrillation ablation a multicenter study, 522–528, Copyright 2009, with permission from Elsevier.

Figure 2.

Twelve-lead electrocardiograms (left) and their corresponding location in the anteroposterior fluoroscopic view (right, red asterisks). The origin of ventricular premature beat (VPB) triggering ventricular fibrillation (VF) was the left Purkinje either at the posterior (A) or the anterior (B) insertion, the right Purkinje (C), and the right ventricular outflow track (D). Related fluoroscopic views with a decapolar catheter inserted in the left ventricle (E and F), an ablation catheter inserted in the right ventricle (G), and a quadripolar catheter inserted at the His position (E to G). Ventricular premature beat originating in the left Purkinje system (A and B and related anteroposterior fluoroscopic view) produce more variable 12-lead electrocardiogram (ECG) patterns, reflecting the more complex and extended Purkinje arborization on the left. VPBs originating in the right Purkinje system (C and related anteroposterior fluoroscopic view) typically have a left bundle-branch block pattern with left superior axis. Ventricular premature beat originating from the right ventricular outflow track (D) have the classical aspect with a left bundle-branch block pattern and an inferior axis. Reprinted from Journal of the American College of Cardiology, 54(6), Knecht S, Sacher F, Wright M, Hocini M, Nogami A, Arentz T, et al., Long term follow up of idiopathic ventricular fibrillation ablation a multicenter study, 522–528, Copyright 2009, with permission from Elsevier.

Figure 3.

Left lateral view of the right ventricular outflow tract (RVOT) displays the difference in ventricular electrograms between the endocardial (ENDO) and epicardial (EPI) site of the anterior RVOT of the same patient. The left and right insets display bipolar and unipolar electrograms recorded from the epicardium and endocardium from the same site of the RVOT, respectively. Bi-DIST indicates bipolar distal; Bi-PROX, bipolar proximal; Uni-DIST, unipolar distal; and Uni-PROX, unipolar proximal. Reprinted from Circulation, 123(12), Nademanee K, Veerakul G, Chandanamattha P, Chaothawee L, Ariyachaipanich A, Jirasirirojanakorn K, et al., Prevention of ventricular fibrillation episodes in Brugada syndrome by catheter ablation over the anterior right ventricular outflow tract epicardium, 1270–79, Copyright 2011, with permission from Wolters Kluwer Health Inc. Promotional and commercial use of the material in print, digital or mobile device format is prohibited without the permission from the publisher Wolters Kluwer Health.

Figure 4.

Comparison of ventricular electrograms recorded from different sites in both the left ventricle (LV) and right ventricle (RV). Reprinted from Circulation, 123(12), Nademanee K, Veerakul G, Chandanamattha P, Chaothawee L, Ariyachaipanich A, Jirasirirojanakorn K, et al., Prevention of ventricular fibrillation episodes in Brugada syndrome by catheter ablation over the anterior right ventricular outflow tract epicardium, 1270–79, Copyright 2011, with permission from Wolters Kluwer Health Inc. Promotional and commercial use of the material in print, digital or mobile device format is prohibited without the permission from the publisher Wolters Kluwer Health.

Figure 5.

The 12-lead ECGs from the same patient, recorded at the beginning and end of the procedure, show normalization of the Brugada ECG pattern during ablation. Reprinted from Circulation, 123(12), Nademanee K, Veerakul G, Chandanamattha P, Chaothawee L, Ariyachaipanich A, Jirasirirojanakorn K, et al., Prevention of ventricular fibrillation episodes in Brugada syndrome by catheter ablation over the anterior right ventricular outflow tract epicardium, 1270–79, Copyright 2011, with permission from Wolters Kluwer Health Inc. Promotional and commercial use of the material in print, digital or mobile device format is prohibited without the permission from the publisher Wolters Kluwer Health.