Substrate-guided ablation of haemodynamically tolerated and untolerated ventricular tachycardia in patients with structural heart disease: effect of cardiomyopathy type and acute success on long-term outcome
| Autor: | Zaev Wulffhart, Vidal Essebag, Alfredo Pantano, Bernice Tsang, Jessica Beardsall, Vagner Pegoraro, Thais Nascimento, Philip Hache, Atul Verma, Jacqueline Joza, Riccardo Proietti, Rasna Juta, Yaariv Khaykin |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Cardiomyopathy
Dilated Epicardial Mapping Male Tachycardia medicine.medical_specialty Heart disease Cardiomyopathy medicine.medical_treatment Myocardial Ischemia Catheter ablation Implantable defibrillator Ventricular tachycardia Cicatrix Recurrence Physiology (medical) Internal medicine Dilated medicine Humans Outcome Aged Proportional Hazards Models Ischemic cardiomyopathy business.industry Hemodynamics Ventricular Dilated cardiomyopathy Middle Aged medicine.disease Cardiac Imaging Techniques Treatment Outcome Case-Control Studies Catheter Ablation Electrophysiologic Techniques Cardiac Female Tachycardia Ventricular Cardiology and Cardiovascular Medicine Cardiology Electrophysiologic Techniques medicine.symptom business Cardiac |
| Zdroj: | Europace. 17:461-467 |
| ISSN: | 1532-2092 1099-5129 |
| Popis: | Aims The purpose of this study was to evaluate the outcomes of purely substrate-guided ventricular tachycardia (VT) ablation in patients with non-ischaemic dilated cardiomyopathy (NIDCM) and ischaemic cardiomyopathy (ICM) and the impact of acute procedural success on long-term outcome. Methods and results One hundred and forty-two patients (65 ± 12 years old, 72% male) with ICM ( n = 87) and with NIDCM ( n = 55) underwent substrate-guided VT ablation. The ablation approach involved eliminating all LP regions and ablating all scar border zone regions with 10 or more out of 12 pace-matching. All patients were followed with regular implantable defibrillator interrogations for mean 641 ± 301 days. Complete acute success (no inducible VT) was achieved in 60 patients with ICM (69%) and in 29 patients with NIDCM (53%) ( P = 0.03). Partial success (elimination of clinical VT only) was obtained in nine patients with ICM (10%) and in four patients with NIDCM (7%) ( P = 0.14). Procedural failure (clinical VT still inducible) occurred in 18 patients within the ICM group (21%) and in 22 patients of the NIDCM (40%) ( P = 0.04). Overall, 51 patients presented with recurrence of ventricular arrhythmias: 23 in the group with ICM (26%) and 28 in the group with NIDCM (51%) ( P = 0.03). Long-term success was related to acute procedural outcome. Conclusions Substrate-guided ablation is an effective approach in the treatment of VT with long-term outcome directly related to acute procedural success. Success rates are significantly lower in patients with NIDCM compared with those with ICM. |
| Databáze: | OpenAIRE |
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