Outcomes after repeat ablation of ventricular tachycardia in structural heart disease: An analysis from the International VT Ablation Center Collaborative Group

被引：33

作者：

Tzou, Wendy S. ^{[1
]}

Tung, Roderick ^{[2
]}

Frankel, David S. ^{[3
]}

Di Biase, Luigi ^{[4
,5
]}

Santangeli, Pasquale ^{[2
]}

Vaseghi, Marmar ^{[6
]}

Bunch, T. Jared ^{[7
]}

Weiss, J. Peter ^{[7
]}

Tholakanahalli, Venkatakrishna N. ^{[8
]}

Lakkireddy, Dhanunjaya ^{[9
]}

Vunnam, Rama ^{[10
]}

Dickfeld, Timm ^{[10
]}

Mathuria, Nilesh ^{[11
]}

Tedrow, Usha ^{[12
]}

Vergara, Pasquale ^{[13
]}

Vakil, Kairav ^{[8
]}

Nakahara, Shiro ^{[14
]}

Burkhardt, J. David ^{[5
]}

Stevenson, William G. ^{[12
]}

Callans, David J.

Della Bella, Paolo ^{[13
]}

Natale, Andrea ^{[5
]}

Shivkumar, Kalyanam ^{[6
]}

Marchlinski, Francis E. ^{[1
,3
]}

Sauer, William H.

机构：

[1] Univ Colorado Hlth Syst, Aurora, CO USA

[2] Univ Chicago, Med Ctr, Chicago, IL 60637 USA

[3] Hosp Univ Penn, 3400 Spruce St, Philadelphia, PA 19104 USA

[4] Albert Einstein Coll Med, Montefiore Med Ctr, New York, NY USA

[5] St Davids Med Ctr, Texas Cardiac Arrhythmia Inst, Austin, TX USA

[6] UCLA Hlth Syst, UCLA Cardiac Arrhythmia Ctr, Los Angeles, CA USA

[7] Intermt Med Ctr, Intermt Heart Inst, Murray, UT USA

[8] Univ Minnesota, Med Ctr, Minneapolis VA Med Ctr, Minneapolis, MN 55455 USA

[9] Univ Kansas, Med Ctr, Kansas City, KS 66103 USA

[10] Univ Maryland, Med Ctr, Baltimore, MD 21201 USA

[11] Texas Heart Inst, Baylor St Lukes Med Ctr, Houston, TX 77025 USA

[12] Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA

[13] Hosp San Raffaele, Milan, Italy

[14] Dokkyo Med Univ, Koshigaya Hosp, Saitama, Japan

来源：

HEART RHYTHM | 2017年 / 14卷 / 07期

关键词：

Ventricular tachycardia; Catheter ablation; Ablation outcomes; CATHETER ABLATION; NONISCHEMIC CARDIOMYOPATHY; ISCHEMIC CARDIOMYOPATHY; RADIOFREQUENCY ABLATION; SUBSTRATE; MULTICENTER; ARRHYTHMIAS; SAFETY; TRIAL; TERM;

D O I：

10.1016/j.hrthm.2017.03.008

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 +/- 0.9, range 1-10). > 1RFA vs 1RFA patients did not differ with regard to age (62 +/- 13 years vs 62 +/- 13 years), left ventricular ejection fraction (33% +/- 13% vs 34% +/- 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 +/- 122 minutes vs 266 +/- 110 minutes), involved more epicardial access (41% vs 21%), induced VTs (2.4 +/- 2.2 vs 1.9 +/- 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 = .07) and venous thrombosis (0.8% vs 0.2%, P = .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 = .003) but was equivalent if successful (93% vs 92%, P = .96). CONCLUSION Patients requiring repeat VT ablation differ significantly from those undergoing first-time ablation. Despite more challenging ablation characteristics, VT-free survival after repeat ablations is encouraging. Mortality is comparable if VT does not recur after RFA at specialized centers.

引用

页码：991 / 997

页数：7