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Russo AD, Casella M, Pieroni M, Pelargonio G, Bartoletti S, Santangeli P, Zucchetti M, Innocenti E, Di Biase L, Carbucicchio C, Bellocci F, Fiorentini C, Natale A, Tondo C. Drug-Refractory Ventricular Tachycardias After Myocarditis. Circ Arrhythm Electrophysiol 2012; 5:492-8. [DOI: 10.1161/circep.111.965012] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background—
Ventricular tachycardia (VT) is a significant therapeutic challenge in patients with myocarditis. This study aimed to assess the efficacy and safety of radiofrequency catheter ablation (RFCA) of VT in patients with myocarditis.
Methods and Results—
We enrolled 20 patients (15 men; age, 42 [28–52] years) with a history of biopsy-proven viral myocarditis and drug-refractory VT; 5 patients presented with electrical storm. The median left ventricular ejection fraction was 55% (45–60%). All patients underwent endocardial RFCA with an irrigated catheter, using contact electroanatomic mapping. Recurrence of sustained VT after endocardial RFCA was treated with additional epicardial RFCA. Endocardial RFCA was acutely successful in 14 patients (70%) while in the remaining 6 (30%) clinical VT was successfully ablated by epicardial RFCA. In 1 patient, hemodynamic instability required an intra-aortic balloon pump to complete RFCA. No major complication occurred during or after RFCA. Over a median follow-up time of 28 (11–48) months, 18 patients (90%) remained free of sustained VT; 2 patients (10%, both with baseline left ventricular ejection fraction ≤35%) died of acute heart failure unrelated to ventricular arrhythmias.
Conclusions—
In patients with myocarditis, RFCA of drug-refractory VT is feasible, safe, and effective. Epicardial RFCA should be considered as an important therapeutic option to increase success rate.
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Affiliation(s)
- Antonio Dello Russo
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
| | - Michela Casella
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
| | - Maurizio Pieroni
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
| | - Gemma Pelargonio
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
| | - Stefano Bartoletti
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
| | - Pasquale Santangeli
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
| | - Martina Zucchetti
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
| | - Ester Innocenti
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
| | - Luigi Di Biase
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
| | - Corrado Carbucicchio
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
| | - Fulvio Bellocci
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
| | - Cesare Fiorentini
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
| | - Andrea Natale
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
| | - Claudio Tondo
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
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