Electrophysiological predictors of ventricular tachycardia recurrence in patients with structural heart disease after combined endo-epicardial substrate catheter ablation

Autor: Evgeny N. Mikhaylov, V. Lebedeva, D Lebedev, A V Kamenev, S Garkina, R B Tatarskiy, M. A. Vander, V. S. Orshanskaya, K. A. Simonova
Rok vydání: 2021
Předmět:
Zdroj: Web of Science
ISSN: 1522-9645
0195-668X
DOI: 10.1093/eurheartj/ehab724.0385
Popis: Background Although there is a tremendous improvement in mapping and ablation techniques over the last decades, the recurrence rate of ventricular tachycardia (VT) in patients with structural heart diseases following endo-epicardial catheter ablation remains high. Purpose To determine predictors of VT recurrence in patients with structural heart disease after combined endo-epicardial radiofrequency (RF) VT ablation. Methods This prospective single-center study included 39 patients (34 men and 5 women, mean age 49.6±16.0 years), who underwent endo-epicardial mapping and ablation of the VT substrate. Etiology of structural heart diseases included: previous myocardial infarction (n=15); non-ischemic cardiomyopathy (n=24: 15 – arrhythmogenic right ventricular cardiomyopathy (ARVC), 6 – myocarditis, 3 – unspecified). First-line epicardial access was performed in 16 patients, as a second approach – in 23 subjects. We evaluated total ventricular myocardial areas, epi- and endocardial areas with bipolar low voltage ( Results Epicardial late potentials were registered in 69% of cases before ablation. Epicardial RF applications were delivered in 67% of patients; while only endocardial RF applications (including cases with intended epicardial substrate modification by endocardial ablation) were present in 28% cases. Non-inducibility of any VT plus abatement of local abnormal electrical activity was achieved in 32 (82%) of cases. The ratio epi/endo bipolar areas Conclusion Regardless of epicardial substrate modification, patients with a larger epicardial low voltage area are more likely to have VT recurrence at 6 months after index ablation. A shorter induced VT cycle length is associated with a larger epicardial low-voltage area. Funding Acknowledgement Type of funding sources: None.
Databáze: OpenAIRE
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