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

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2012年 / 60卷 / 02期

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

页码：132 / 141

页数：10

共 36 条

[21] ILLUSION OF REPERFUSION - DOES ANYONE ACHIEVE OPTIMAL REPERFUSION DURING ACUTE MYOCARDIAL-INFARCTION (CIRCULATION, PG 1792, JUNE 1993) [J].