Substrate-guided ablation of haemodynamically tolerated and untolerated ventricular tachycardia in patients with structural heart disease: effect of cardiomyopathy type and acute success on long-term outcome

被引:42
作者
Proietti, Riccardo [1 ,2 ]
Essebag, Vidal [1 ,3 ]
Beardsall, Jessica [4 ]
Hache, Philip [4 ]
Pantano, Alfredo [4 ]
Wulffhart, Zaev [4 ]
Juta, Rasna [4 ]
Tsang, Bernice [4 ]
Joza, Jacqueline [1 ]
Nascimento, Thais [1 ]
Pegoraro, Vagner [1 ]
Khaykin, Yaariv [4 ]
Verma, Atul [1 ,4 ]
机构
[1] McGill Univ, Ctr Hlth, Montreal, PQ, Canada
[2] Luigi Sacco Hosp, Dept Cardiol, Milan, Italy
[3] Hop Sacre Coeur Montreal, Montreal, PQ, Canada
[4] Heart Rhythm Program, Southlake Reg Hlth Ctr, Newmarket, ON L3Y 2P6, Canada
来源
EUROPACE | 2015年 / 17卷 / 03期
基金
加拿大健康研究院;
关键词
Catheter ablation; Cardiomyopathy; Ventricular tachycardia; Outcome; RADIOFREQUENCY CATHETER ABLATION; NONISCHEMIC CARDIOMYOPATHY; SINUS RHYTHM; MANAGEMENT; COMPLICATIONS; ELECTROGRAMS; IMPACT; SITES; SCAR;
D O I
10.1093/europace/euu326
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims 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. Methods and results One hundred and forty-two patients (65 +/- 12 years old, 72% male) with ICM (n = 87) and with NIDCM (n = 55) under-went 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 inducible) occurred in 18 patients within the ICM group (21%) and in 22 patients of the NIDCM (40%) (P = 0.04). Overall, 51 patients presented with recurrence of ventricular arrhythmias: 23 in the group with ICM (26%) and 28 in the group with NIDCM (51%) (P = 0.03). Long-term success was related to acute procedural outcome. Conclusion Substrate-guided ablation is an effective approach in the treatment of VT with tong-term outcome directly related to acute procedural success. Success rates are significantly lower in patients with NIDCM compared with those with ICM.
引用
收藏
页码:461 / 467
页数:7
相关论文
共 29 条
[1]   EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias [J].
Aliot, Etienne M. ;
Stevenson, William G. ;
Almendral-Garrote, Jesus Ma ;
Bogun, Frank ;
Calkins, C. Hugh ;
Delacretaz, Etienne ;
Della Bella, Paolo ;
Hindricks, Gerhard ;
Jais, Pierre ;
Josephson, Mark E. ;
Kautzner, Josef ;
Kay, G. Neal ;
Kuck, Karl-Heinz ;
Lerman, Bruce B. ;
Marchlinski, Francis ;
Reddy, Vivek ;
Schalij, Martin-Jan ;
Schilling, Richard ;
Soejima, Kyoko ;
Wilber, David .
EUROPACE, 2009, 11 (06) :771-817
[2]   Tachycardia-related channel in the scar tissue in patients with sustained monomorphic ventricular tachycardias -: Influence of the voltage scar definition [J].
Arenal, A ;
del Castillo, S ;
Gonzalez-Torrecilla, E ;
Atienza, F ;
Ortiz, M ;
Jimenez, J ;
Puchol, A ;
García, J ;
Almendral, J .
CIRCULATION, 2004, 110 (17) :2568-2574
[3]   Ablation of electrograms with an isolated, delayed component as treatment of unmappable monomorphic ventricular tachycardias in patients with structural heart disease [J].
Arenal, A ;
Glez-Torrecilla, E ;
Ortiz, M ;
Villacastín, J ;
Fdez-Portales, J ;
Sousa, E ;
del Castillo, S ;
de Isla, LP ;
Jimenez, J ;
Almendral, J .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2003, 41 (01) :81-92
[4]   Isolated potentials during sinus rhythm and pace-mapping within scars as guides for ablation of post-infarction ventricular tachycardia [J].
Bogun, F ;
Good, E ;
Reich, S ;
Elmouchi, D ;
Igic, P ;
Lemola, K ;
Tschopp, D ;
Jongnarangsin, K ;
Oral, H ;
Chugh, A ;
Pelosi, F ;
Morady, F .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2006, 47 (10) :2013-2019
[5]   Analysis during sinus rhythm of critical sites in reentry circuits of postinfarction ventricular tachycardia [J].
Bogun, F ;
Bender, B ;
Li, YG ;
Groenefeld, G ;
Hohnloser, SH ;
Pelosi, F ;
Knight, B ;
Strickberger, SA ;
Morady, F .
JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY, 2002, 7 (01) :95-103
[6]   Electroanatomic Substrate and Ablation Outcome for Suspected Epicardial Ventricular Tachycardia in Left Ventricular Nonischemic Cardiomyopathy [J].
Cano, Oscar ;
Hutchinson, Mathew ;
Lin, David ;
Garcia, Fermin ;
Zado, Erica ;
Bala, Rupa ;
Riley, Michael ;
Cooper, Joshua ;
Dixit, Sanjay ;
Gerstenfeld, Edward ;
Callans, David ;
Marchlinski, Francis E. .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2009, 54 (09) :799-808
[7]   High-density substrate-guided ventricular tachycardia ablation: Role of activation mapping in an attempt to improve procedural effectiveness [J].
Carbucicchio, Corrado ;
Raja, Nadeem Ahmad ;
Di Biase, Luigi ;
Volpe, Valeria ;
Dello Russo, Antonio ;
Trivedi, Chintan ;
Bartoletti, Stefano ;
Zucchetti, Martina ;
Casella, Michela ;
Russo, Eleonora ;
Santangeli, Pasquale ;
Moltrasio, Massimo ;
Tundo, Fabrizio ;
Fassini, Gaetano ;
Natale, Andrea ;
Tondo, Claudio .
HEART RHYTHM, 2013, 10 (12) :1850-1858
[8]   Fibrosis and Cardiac Arrhythmias [J].
de Jong, Sanne ;
van Veen, Toon A. B. ;
van Rijen, Harold V. M. ;
de Bakker, Jacques M. T. .
JOURNAL OF CARDIOVASCULAR PHARMACOLOGY, 2011, 57 (06) :630-638
[9]   Management of Ventricular Tachycardia in the Setting of a Dedicated Unit for the Treatment of Complex Ventricular Arrhythmias Long-Term Outcome After Ablation [J].
Della Bella, Paolo ;
Baratto, Francesca ;
Tsiachris, Dimitris ;
Trevisi, Nicola ;
Vergara, Pasquale ;
Bisceglia, Caterina ;
Petracca, Francesco ;
Carbucicchio, Corrado ;
Benussi, Stefano ;
Maisano, Francesco ;
Alfieri, Ottavio ;
Pappalardo, Federico ;
Zangrillo, Alberto ;
Maccabelli, Giuseppe .
CIRCULATION, 2013, 127 (13) :1359-1368
[10]   Endo-Epicardial Homogenization of the Scar Versus Limited Substrate Ablation for the Treatment of Electrical Storms in Patients With Ischemic Cardiomyopathy [J].
Di Biase, Luigi ;
Santangeli, Pasquale ;
Burkhardt, David J. ;
Bai, Rong ;
Mohanty, Prasant ;
Carbucicchio, Corrado ;
Dello Russo, Antonio ;
Casella, Michela ;
Mohanty, Sanghamitra ;
Pump, Agnes ;
Hongo, Richard ;
Beheiry, Salwa ;
Pelargonio, Gemma ;
Santarelli, Pietro ;
Zucchetti, Martina ;
Horton, Rodney ;
Sanchez, Javier E. ;
Elayi, Claude S. ;
Lakkireddy, Dhanunjay ;
Tondo, Claudio ;
Natale, Andrea .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2012, 60 (02) :132-141