Unmappable ventricular tachycardia after an old myocardial infarction. Long-term results of substrate modification in patients with an implantable cardioverter defibrillator
Autor: | Carl Timmermans, Hein J.J. Wellens, Luz-Maria Rodriguez, Piet J. M. Portegijs, Robert Dennert, Suzanne Philippens, Becker S. N. Alzand |
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Přispěvatelé: | RS: CARIM School for Cardiovascular Diseases, RS: CAPHRI School for Public Health and Primary Care, MUMC+: MA Med Staf Spec Cardiologie (9), Cardiologie, RS: CARIM - R2.01 - Clinical atrial fibrillation, MUMC+: MA Alg Ond Onderz Cardiologie (9), Family Medicine |
Jazyk: | angličtina |
Rok vydání: | 2011 |
Předmět: |
Male
Tachycardia medicine.medical_specialty Time Factors medicine.medical_treatment Myocardial Infarction Catheter ablation Kaplan-Meier Estimate Follow-up studies Ablation Ventricular tachycardia Risk Assessment Statistics Nonparametric Article Cohort Studies Electrocardiography Recurrence Physiology (medical) Internal medicine Humans Medicine cardiovascular diseases Myocardial infarction Aged Retrospective Studies Substrate modification Academic Medical Centers medicine.diagnostic_test business.industry Body Surface Potential Mapping Middle Aged Implantable cardioverter-defibrillator medicine.disease Combined Modality Therapy Tachyarrhythmia Defibrillators Implantable Treatment Outcome Catheter Ablation Tachycardia Ventricular cardiovascular system Cardiology Myocardial infarction complications Female Myocardial infarction diagnosis medicine.symptom Cardiology and Cardiovascular Medicine business |
Zdroj: | Journal of Interventional Cardiac Electrophysiology, 31(2), 149-156. Springer Journal of Interventional Cardiac Electrophysiology |
ISSN: | 1383-875X |
DOI: | 10.1007/s10840-011-9549-1 |
Popis: | Purpose The frequent occurrence of ventricular tachycardia can create a serious problem in patients with an implantable cardioverter defibrillator. We assessed the long-term efficacy of catheter-based substrate modification using the voltage mapping technique of infarct-related ventricular tachycardia and recurrent device therapy. Methods The study population consisted of 27 consecutive patients (age 68 +/- 8 years, 25 men, mean left ventricular ejection fraction 31 +/- 9%) with an old myocardial infarction and multiple and/or hemodynamically not tolerated ventricular tachycardia necessitating repeated device therapy. A total of 31 substrate modification procedures were performed using the three-dimensional electroanatomical mapping system. Patients were followed up for a median of 23.5 (interquartile range 6.5-53.2) months before and 37.8 (interquartile range 11.7-71.8) months after ablation. Antiarrhythmic drugs were not changed after the procedure, and were stopped 6 to 9 months after the procedure in patients who did not show ventricular tachycardia recurrence. Results Median ventricular tachycardias were 1.6 (interquartile range 0.7-6.7) per month before and 0.2 (interquartile range 0.00-1.3) per month after ablation (P = 0.006). Nine ventricular fibrillation episodes were registered in seven patients before and two after ablation (P = 0.025). Median antitachycardia pacing decreased from 1.6 (interquartile range 0.01-5.5) per month before to 0.18 (interquartile range 0.00-1.6) per month after ablation (P = 0.069). Median number of shocks decreased from 0.19 (interquartile range 0.04-0.81) per month before to 0.00 (interquartile range 0.00-0.09) per month after ablation (P = 0.001). One patient had a transient ischemic attack during the procedure, and another developed pericarditis. Nine patients died during follow-up, eight patients due to heart failure and one patient during valve surgery. Conclusion Catheter-based substrate modification using voltage mapping results in a long-lasting reduction of cardioverter defibrillator therapy in patients with multiple and/or hemodynamically not tolerated infarct-related ventricular tachyarrhythmia. |
Databáze: | OpenAIRE |
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