Long-term outcomes of ablation for ventricular arrhythmias in mitral valve prolapse

Autor: Nitish Badhwar, Francesca N. Delling, Gregory M. Marcus, Paul J Marano, José M. Sanchez, Gregory Nah, Edward P. Gerstenfeld, Lisa J. Lim, Raza M. Alvi, Zian H. Tseng
Rok vydání: 2020
Předmět:
medicine.medical_treatment
Cardiorespiratory Medicine and Haematology
030204 cardiovascular system & hematology
Cardiovascular
Ventricular tachycardia
0302 clinical medicine
Tachycardia
Mitral valve prolapse
030212 general & internal medicine
Ventricular arrhythmia ablation procedures
Mitral Valve Prolapse
valvular heart disease
Ablation
Implantable cardioverter-defibrillator
Ventricular Premature Complexes
Defibrillators
Implantable
Heart Disease
medicine.anatomical_structure
Ventricular Fibrillation
Cardiology
Catheter Ablation
Female
Implantable
medicine.symptom
Cardiology and Cardiovascular Medicine
medicine.medical_specialty
Article
03 medical and health sciences
Clinical Research
Physiology (medical)
Internal medicine
medicine
Humans
Premature ventricular beats
Papillary muscle
Mitral regurgitation
Fibrillation
business.industry
Ventricular
Infant
Newborn
Infant
Newborn
medicine.disease
Valvular heart disease
Cardiovascular System & Hematology
Tachycardia
Ventricular
business
Defibrillators
Zdroj: J Interv Card Electrophysiol
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, vol 61, iss 1
ISSN: 1572-8595
Popis: OBJECTIVE: Prior studies reporting efficacy of radiofrequency catheter ablation for complex ventricular ectopy in mitral valve prolapse (MVP) are limited by selective inclusion of bileaflet MVP, papillary muscle only ablation or short-term follow-up. We sought to evaluate the long-term incidence of hemodynamically significant ventricular tachycardia (VT) or fibrillation (VF) in patients with MVP after initial ablation. METHODS AND RESULTS: We studied consecutive patients with MVP undergoing ablation for complex ventricular ectopy between 2013 and 2017 at our institution. Of 580 patients with MVP, we included 15 (2.6%, 10 women; mean age 50 ± 14 years, 53% bileaflet) with complex ventricular ectopy treated with initial ablation. Over a median follow-up of 3,406 (1,875-6,551) days or 9 years, 5 of 15 (33%) patients developed hemodynamically significant VT/VF after their initial ablation, and underwent placement of an implantable cardioverter defibrillator (ICD). Three of 5 also underwent repeat ablations. Sustained VT was inducible prior to index ablation in all 5 who developed VT/VF, compared to none of the 10 patients who did not develop VT/VF after index ablation (p = 0.002). Complex ventricular ectopy at index ablation was multifocal in all 5 patients who underwent repeat intervention versus 4 of 10 patients (40%) who did not (p = 0.04). All 3 patients with subsequent VT/VF who underwent repeat ablation had a new clinically dominant focus of ventricular arrhythmia and 3 of the patients with ICD had appropriate VT/VF therapies. CONCLUSIONS: In the long-term, a subset of MVP patients treated with ablation for ventricular arrhythmias, all with multifocal ectopy on initial EP study, develop hemodynamically significant VT/VF. Our findings suggest the progressive nature of ventricular arrhythmias in patients with MVP and multifocal ectopy.
Databáze: OpenAIRE
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