Stepwise Approach for Ventricular Tachycardia Ablation in Patients With Predominantly Intramural Scar

被引:18
作者
Ghannam, Michael [1 ]
Siontis, Konstantinos C. [1 ]
Kim, Hyungjin Myra [1 ]
Cochet, Hubert [2 ,3 ,4 ]
Jais, Pierre [2 ,3 ,4 ]
Juhoor, Mehdi [2 ,3 ,4 ]
Latchamsetty, Rakesh [1 ]
Jongnarangsin, Krit [1 ]
Attili, Anil [1 ]
Dabbagh, Ghaith Sharaf [1 ]
Yokokawa, Miki [1 ]
Morady, Fred [1 ]
Bogun, Frank [1 ]
机构
[1] Univ Michigan, Ann Arbor, MI 48109 USA
[2] Bordeaux Univ Hosp, Bordeaux, France
[3] Univ Bordeaux, Bordeaux, France
[4] INRIA, Sophia Antipolis, France
基金
欧洲研究理事会;
关键词
cardiac magnetic resonance; cardiomyopathy; catheter ablation; delayed enhancement; intramural scar; radiofrequency ablation; ventricular tachycardia; NONISCHEMIC CARDIOMYOPATHY; CATHETER ABLATION; SUBSTRATE; ACCURATE; ATRIAL;
D O I
10.1016/j.jacep.2019.11.020
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES The goal of this study was to assess the value of a stepwise, image-guided ablation approach in patients with cardiomyopathy and predominantly intramural scar. BACKGROUND Few reports have focused on catheter-based ventricular tachycardia (VT) ablation strategies in patients with predominantly intramural scar. METHODS The study included patients with predominantly intramural scar undergoing VT ablation. A stepwise strategy was performed consisting of a localized ablation guided by conventional mapping criteria followed by a more extensive ablation if VT remained inducible. The extensive ablation was guided by the location and extent of intramural scarring on delayed enhanced-cardiac magnetic resonance imaging. A historical cohort who did not undergo additional extensive ablation was identified for comparison. A novel measurement, the scar depth index (SDI), indicating the percent area of the scar at a given depth, was correlated with outcomes. RESULTS Forty-two patients who underwent stepwise ablation (median age 61 years [interquartile range: 55 to 69 years], 35 male patients, median left ventricular ejection fraction 36.0% [25.0% to 55.0%], ischemic [n = 4] or nonischemic cardiomyopathy [n = 38]) were followed up for a median of 17 months (8 to 36 months). A stepwise approach resulted in a 1-year freedom from VT, death, or cardiac transplantation of 76% (32 of 42). Patients who underwent additional extensive ablation had a lower risk of events than a clinically similar historical cohort (N = 19) (hazard ratio: 0.30; 95% CI: 0.13 to 0.68; p < 0.004). SDI>5mm was associated with worse long-term outcomes (hazard ratio: 1.03; 95% CI: 1.01 to 1.06%; p = 0.03), SDI>5mm >16.5% was associated with failed ablation (area under the curve: 0.84; 95% CI: 0.71 to 0.97). CONCLUSIONS Stepwise ablation using delayed enhanced-cardiac magnetic resonance guidance is a novel approach to VT ablation in patients with predominantly intramural scarring. The SDI correlates with immediate procedural and long-term outcomes. (C) 2020 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved.
引用
收藏
页码:448 / 460
页数:13
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