Endo-Epicardial Homogenization of the Scar Versus Limited Substrate Ablation for the Treatment of Electrical Storms in Patients With Ischemic Cardiomyopathy

被引:306
作者
Di Biase, Luigi [1 ,2 ,3 ]
Santangeli, Pasquale [1 ,3 ]
Burkhardt, David J. [1 ,4 ]
Bai, Rong [1 ]
Mohanty, Prasant [1 ]
Carbucicchio, Corrado [5 ]
Dello Russo, Antonio [5 ]
Casella, Michela [5 ]
Mohanty, Sanghamitra [1 ]
Pump, Agnes [1 ,6 ]
Hongo, Richard [4 ]
Beheiry, Salwa [4 ]
Pelargonio, Gemma [7 ]
Santarelli, Pietro [7 ]
Zucchetti, Martina [5 ]
Horton, Rodney [1 ]
Sanchez, Javier E. [1 ]
Elayi, Claude S. [8 ]
Lakkireddy, Dhanunjay [9 ]
Tondo, Claudio [5 ]
Natale, Andrea [1 ,2 ,4 ]
机构
[1] St Davids Med Ctr, Texas Cardiac Arrhythmia Inst, Austin, TX 78705 USA
[2] Univ Texas Austin, Dept Biomed Engn, Austin, TX 78712 USA
[3] Univ Foggia, Dept Cardiol, Foggia, Italy
[4] Calif Pacific Med Ctr, San Francisco, CA USA
[5] Ist Ricovero & Cura Carattere Sci, Cardiac Arrhythmia Res Ctr, Ctr Cardiol Monzino, Milan, Italy
[6] Univ Pecs, Inst Heart, Fac Med, Pecs, Hungary
[7] Univ Cattolica Sacro Cuore, Rome, Italy
[8] Univ Kentucky, Lexington, KY USA
[9] Univ Kansas, Kansas City, KS USA
关键词
catheter ablation; electrical storm; electrophysiology; epicardial; irrigated tip catheter; ischemic cardiomyopathy; mapping; myocardial infarction; scar; ventricular tachycardia; IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS; POSTINFARCTION VENTRICULAR-TACHYCARDIA; RADIOFREQUENCY CATHETER ABLATION; ACUTE MYOCARDIAL-INFARCTION; HEART-DISEASE; TERM; PREDICTORS; RECURRENT; CLUSTERS; FEATURES;
D O I
10.1016/j.jacc.2012.03.044
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives This study investigated the impact on recurrences of 2 different substrate approaches for the treatment of these arrhythmias. Background Catheter ablation of electrical storms (ES) for ventricular arrhythmias (VAs) has shown moderate long-term efficacy in patients with ischemic cardiomyopathy. Methods Ninety-two consecutive patients (81% male, age 62 +/- 13 years) with ischemic cardiomyopathy and ES underwent catheter ablation. Patients were treated either by confining the radiofrequency lesions to the endocardial surface with limited substrate ablation (Group 1, n = 49) or underwent endocardial and epicardial ablation of abnormal potentials within the scar (homogenization of the scar, Group 2, n = 43). Epicardial access was obtained in all Group 2 patients, whereas epicardial ablation was performed in 33% (14) of these patients. Results Mean ejection fraction was 27 +/- 5. During a mean follow-up of 25 +/- 10 months, the VAs recurrence rate of any ventricular tachycardia (VTs) was 47% (23 of 49 patients) in Group 1 and 19% (8 of 43 patients) in Group 2 (log-rank p = 0.006). One patient in Group 1 and 1 patient in Group 2 died at follow-up for noncardiac reasons. Conclusions Our study demonstrates that ablation using endo-epicardial homogenization of the scar significantly increases freedom from VAs in ischemic cardiomyopathy patients. (J Am Coll Cardiol 2012;60:132-41) (C) 2012 by the American College of Cardiology Foundation
引用
收藏
页码:132 / 141
页数:10
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