P1125 Safety and efficacy of ventricular tachycardia ablation during sinus rhythm in patients with structural heart disease (original) (raw)
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Ablation of Ventricular Tachycardia in Patients with Structural Heart Disease
Pace-pacing and Clinical Electrophysiology, 2008
Catheter ablation is an important therapeutic option for controlling recurrent ventricular arrhythmias in patients with heart disease. Although implantable defibrillators are generally first line therapy in this patient population, a substantial number of patients require additional therapy with either antiarrhythmic drugs, ablation, or both. Studies of mapping and ablation have produced further insights into pathophysiologic mechanisms of these arrhythmias, which are now well characterized. The majority is due to reentry through regions of ventricular scar. Methods for identifying scar based on electrogram characteristics now allow arrhythmogenic areas to be targeted for ablation during stable sinus rhythm, such that ablation is often an option even when multiple and unstable ventricular tachycardia are present. Ablation failure can also be due to anatomical obstacles; however, methods for accessing the pericardial space for mapping and ablation and technological progress can be expected to further improve its efficacy.
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2014
The purpose of this study was to evaluate the outcomes of purely substrate-guided ventricular tachycardia (VT) ablation in patients with non-ischaemic dilated cardiomyopathy (NIDCM) and ischaemic cardiomyopathy (ICM) and the impact of acute procedural success on long-term outcome. One hundred and forty-two patients (65 ± 12 years old, 72% male) with ICM (n = 87) and with NIDCM (n = 55) underwent substrate-guided VT ablation. The ablation approach involved eliminating all LP regions and ablating all scar border zone regions with 10 or more out of 12 pace-matching. All patients were followed with regular implantable defibrillator interrogations for mean 641 ± 301 days. Complete acute success (no inducible VT) was achieved in 60 patients with ICM (69%) and in 29 patients with NIDCM (53%) (P = 0.03). Partial success (elimination of clinical VT only) was obtained in nine patients with ICM (10%) and in four patients with NIDCM (7%) (P = 0.14). Procedural failure (clinical VT still inducib...
Circulation. Arrhythmia and electrophysiology, 2014
The effects of time to referral for catheter ablation (CA) of scar-related ventricular tachycardia (VT) on acute success, VT recurrence, and cardiac mortality are unclear. We investigated 300 patients after CA of sustained VT. CA was performed within 30 days after the first documented VT in 75 (25%) patients (group 1), between 1 month and 1 year in 84 (28%) patients (group 2), and >1 year after the first VT occurrence in 141 (47%) patients (group 3). The end points were noninducibility of any VT after CA (acute success), VT recurrence and cardiac mortality after 2 years. Acute success was achieved in 66 (88%) patients in group 1, 68 (81%) in group 2, and in 99 (70.2%) in group 3 (P=0.008). During the 2-year follow-up period, VT recurred in 28 (37.3%) patients in group 1, 52 (61.9%) patients in group 2, and 91 (64.5%) patients in group 3 (P<0.0001). Recurrence-free survival was higher in group 1, as compared with group 2 (hazard ratio [HR], 1.85; P=0.009) and group 3 (HR, 2.04;...
Journal of cardiovascular electrophysiology, 2016
Substrate-based ablation for scar-related ventricular tachycardia (VT) has gained prominence: however, there is limited data comparing it to ablation guided predominantly by activation and entrainment mapping of inducible and hemodynamically tolerated VTs. We compared the acute procedural efficacy and outcomes of predominantly substrate-based ablation versus ablation guided predominantly by activation and entrainment mapping. Database searches through April 2016 identified 6 eligible studies (enrolling 403 patients, with 1 randomized study) comparing the two strategies. The relative risk of VT recurrence at follow-up was assessed as the primary outcome using a random-effects meta-analysis. Secondary endpoints of acute success (based on non-inducibility of VT), procedural complications, and mortality were assessed using weighted mean difference with the random effects model. At a median follow-up of 18 months, the relative risk (RR) of VT recurrence was not significantly different wi...
Heart Rhythm, 2017
BACKGROUND Data evaluating repeat radiofrequency ablation (.1RFA) of ventricular tachycardia (VT) are limited. OBJECTIVE The purpose of this study was to determine the safety and outcomes of VT .1RFA in patients with structural heart disease. METHODS Patients with structural heart disease undergoing VT RFA at 12 centers with data on prior RFA history were included. Characteristics and outcomes were compared between first-time (1RFA) and .1RFA patients. RESULTS Of 1990 patients, 740 had .1RFA (mean 1.4 6 0.9, range 1-10). .1RFA vs 1RFA patients did not differ with regard to age (62 6 13 years vs 62 6 13 years), left ventricular ejection fraction (33% 6 13% vs 34% 6 13%), or sex (88% vs 87% men), but they more often were nonischemic (53% vs 41%), had implantable cardioverter-defibrillator shocks (70% vs 63%) or VT storm (38% vs 33%), and had been treated with amiodarone (55% vs 48%) or 2 antiarrhythmic drugs (22% vs 14%). .1RFA procedures were longer (300 6 122 minutes vs 266 6 110 minutes), involved more epicardial access (41% vs 21%), induced VTs (2.4 6 2.2 vs 1.9 6 1.6) and only unmappable VTs (15% vs 9%), and VT was more often inducible after RFA (42% vs 33%, all P ,.03). Total complications were higher for .1RFA vs 1RFA (8% vs 5%, P ,.01), mostly related to pericardial effusion (2.4% vs 1.3%, P 5 .07) and venous thrombosis (0.8% vs 0.2%, P 5 .06). VT recurrence was higher for .1RFA vs 1RFA (29% vs 24%, P ,.001). Survival was worse for .1RFA vs 1RFA if VT recurred (67% vs 78%, P 5 .003) but was equivalent if successful (93% vs 92%, P 5 .96).