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
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
načítá se...