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Xu L, Khoshknab M, Moss J, Berger RD, Chrispin J, Callans D, Marchlinski FE, Zimmerman SL, Han Y, Trayanova N, Desjardins B, Nazarian S. Lipomatous Metaplasia Is Associated With Ventricular Tachycardia Recurrence Following Ablation in Patients With Nonischemic Cardiomyopathy. JACC Clin Electrophysiol 2024:S2405-500X(24)00170-1. [PMID: 38703163 DOI: 10.1016/j.jacep.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/19/2024] [Accepted: 02/05/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Ventricular tachycardia (VT) recurrence rates remain high following ablation among patients with nonischemic cardiomyopathy (NICM). OBJECTIVES This study sought to define the prevalence of lipomatous metaplasia (LM) in patients with NICM and VT and its association with postablation VT recurrence. METHODS From patients who had ablation of left ventricular VT, we retrospectively identified 113 consecutive NICM patients with preprocedural contrast-enhanced cardiac computed tomography (CECT), from which LM was segmented. Nested within this cohort were 62 patients that prospectively underwent CECT and cardiac magnetic resonance from which myocardial border zone and dense late gadolinium enhancement (LGE) were segmented. A control arm of 30 NICM patients without VT with CECT was identified. RESULTS LM was identified among 57% of control patients without VT vs 83% of patients without VT recurrence and 100% of patients with VT recurrence following ablation. In multivariable analyses, LM extent was the only independent predictor of VT recurrence, with an adjusted HR per 1-g LM increase of 1.1 (P < 0.001). Patients with LM extent ≥2.5 g had 4.9-fold higher hazard of VT recurrence than those with LM <2.5 g (P < 0.001). In the nested cohort with 32 VT recurrences, LM extent was independently associated with VT recurrence after adjustment for border zone and LGE extent (HR per 1 g increase: 1.1; P = 0.036). CONCLUSIONS Myocardial LM is prevalent in patients with NICM of a variety of etiologies, and its extent is associated with postablation VT recurrence independent of the degree of fibrosis.
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Affiliation(s)
- Lingyu Xu
- Cardiovascular Medicine Division, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Mirmilad Khoshknab
- Cardiovascular Medicine Division, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Juwann Moss
- Cardiovascular Medicine Division, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ronald D Berger
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA; Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jonathan Chrispin
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA; Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - David Callans
- Cardiovascular Medicine Division, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Francis E Marchlinski
- Cardiovascular Medicine Division, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Stefan L Zimmerman
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yuchi Han
- Cardiovascular Medicine Division, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Natalia Trayanova
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Benoit Desjardins
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Saman Nazarian
- Cardiovascular Medicine Division, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
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Santangeli P, Higuchi K, Sroubek J. Ventricular Tachycardia Ablation Endpoints: Moving Beyond Noninducibility. JACC Clin Electrophysiol 2024:S2405-500X(24)00003-3. [PMID: 38385913 DOI: 10.1016/j.jacep.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/08/2023] [Accepted: 12/30/2023] [Indexed: 02/23/2024]
Abstract
In patients with structural heart disease and ventricular tachycardia (VT) undergoing catheter ablation, the response to programmed electrical stimulation (PES) at the end of the procedure has been traditionally used to evaluate the acute success and predict long-term outcomes. Although noninducibility at PES has been extensively investigated and validated in clinical trials and large multicenter registries, its performance in predicting long-term freedom from VT is suboptimal. In addition, PES has inherent limitations related to the influence of background antiarrhythmic drug therapy, periprocedural use of anesthesia, and the heterogeneity in PES protocols. The increased utilization of substrate-based ablation approaches that focus on ablation of abnormal electrograms identified with mapping in sinus or paced rhythm has been paralleled by a need for additional procedural endpoints beyond VT noninducibility at PES. This article critically appraises the relative merits and limitations of different procedural endpoints according to different ablation techniques for catheter ablation of scar-related VT.
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Affiliation(s)
- Pasquale Santangeli
- Section of Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
| | - Koji Higuchi
- Section of Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jakub Sroubek
- Section of Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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Lucas P, Sciacca V, Sommer P, Fink T. [Long-term results of catheter ablation of idiopathic and structural ventricular tachycardia]. Herzschrittmacherther Elektrophysiol 2023; 34:298-304. [PMID: 37855890 DOI: 10.1007/s00399-023-00964-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/20/2023] [Indexed: 10/20/2023]
Abstract
Catheter ablation of ventricular tachycardia (VTs) has emerged as an effective treatment modality. Ablation procedures for idiopathic VTs depends on the anatomical origin of the arrhythmias, is highly effective in certain cases, and has been implemented as a first-line therapy in recent European guidelines. In contrast, catheter ablation of VTs in patients with structural heart disease has a significant risk of arrhythmia recurrence. Interventional treatment for patients with ischemic cardiomyopathy was studied in multiple randomized multicenter trials and it was shown that catheter ablation was more effective in arrhythmia suppression compared to conservative treatment modalities. Catheter ablation of nonischemic cardiomyopathy suffers from far higher rates of arrhythmia recurrences as documented in several long-term studies and often needs complex procedures with or without epicardial mapping and ablation. There is still no clear proof of a mortality benefit from catheter ablation of VTs in patients with or without structural heart disease. Nevertheless, recent guidelines recommend catheter ablation as an alternative to implantation of cardioverter-defibrillators (ICD) in selected cases.
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Affiliation(s)
- Philipp Lucas
- Klinik für Elektrophysiologie und Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland
| | - Vanessa Sciacca
- Klinik für Elektrophysiologie und Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie und Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland.
| | - Thomas Fink
- Klinik für Elektrophysiologie und Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland
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Zeppenfeld K, Kimura Y, Ebert M. Mapping and Ablation of Ventricular Tachycardia in Inherited Left Ventricular Cardiomyopathies. JACC Clin Electrophysiol 2023:S2405-500X(23)00816-2. [PMID: 38127011 DOI: 10.1016/j.jacep.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/12/2023] [Accepted: 10/23/2023] [Indexed: 12/23/2023]
Abstract
Advances in the field of human genetics have led to an accumulating understanding of the genetic basis of distinct nonischemic cardiomyopathies associated with ventricular tachycardias (VTs) and sudden cardiac death. To date, there is an increasing proportion of patients with inherited cardiomyopathies requiring catheter ablation for VTs. This review provides an overview of disease-causing gene mutations frequently encountered and relevant for clinical electrophysiologists. Available data on VT ablation in patients with an inherited etiology and a phenotype of a nondilated left ventricular cardiomyopathy, dilated cardiomyopathy, or hypertrophic cardiomyopathy are summarized. VTs amenable to catheter ablation are related to nonischemic fibrosis. Recent insights into genotype-phenotype relations of subtype and location of fibrosis have important implications for treatment planning. Current strategies to delineate nonischemic fibrosis and related arrhythmogenic substrates using multimodal imaging, image integration, and electroanatomical mapping are provided. The ablation approach depends on substrate location and extension. Related procedural aspects including patient-tailored (enhanced) ablation strategies and outcomes are outlined. Challenging substrates for VT and the underlying inherited etiologies with a high risk for rapid progressive heart failure contribute to poor outcomes after catheter ablation. Electroanatomical data obtained during ablation may allow the identification of patients at particular risk who need to be considered for early work-up for left ventricular assist device implantation or heart transplantation.
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Affiliation(s)
- Katja Zeppenfeld
- Department of Cardiology, Heart-Lung-Center, Leiden University Medical Center, Leiden, the Netherlands; Willem Einthoven Center of Arrhythmia Research and Management, Leiden, the Netherlands, and Aarhus, Denmark.
| | - Yoshitaka Kimura
- Department of Cardiology, Heart-Lung-Center, Leiden University Medical Center, Leiden, the Netherlands; Willem Einthoven Center of Arrhythmia Research and Management, Leiden, the Netherlands, and Aarhus, Denmark
| | - Micaela Ebert
- Department of Cardiology, Heart-Lung-Center, Leiden University Medical Center, Leiden, the Netherlands; Division of Electrophysiology, Department of Internal Medicine and Cardiology, Heart Center Dresden, Technische Universität Dresden, Dresden, Germany
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Wu N, Chen H, Ju W, Li M, Gu K, Wang Z, Liu H, Shi J, Jiang X, Cui C, Cai C, Yang G, Chen M. Arrhythmogenic Right Ventricular Cardiomyopathy With Extensive Abnormal Substrate: Is Isolation Possible? JACC Clin Electrophysiol 2023; 9:1455-1463. [PMID: 37269285 DOI: 10.1016/j.jacep.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND In arrhythmogenic right ventricular cardiomyopathy (ARVC) patients with extensive right ventricular free wall (RVFW) abnormal substrate, large-area homogenization with combined epicardial and endocardial approach is time consuming and often inadequate for modification. OBJECTIVES This study aimed to explore the feasibility and efficacy of RVFW abnormal substrate isolation in such patients to control ventricular tachycardia (VT). METHODS Eight consecutive ARVC patients with VT who had extensive abnormal RVFW substrate were included. VT induction was performed before substrate mapping and modification. Detailed voltage mapping was done during sinus rhythm. A circumferential linear lesion was deployed along the border zone of low-voltage area on the RVFW to achieve electrical isolation. Other small areas with fractionated or late potentials were further homogenized. RESULTS All 8 patients had RVFW endocardial low-voltage area. The entire RV low-voltage area was 113.8 ± 84.1 cm2 (49.6% ± 29.8%) and the dense scar was 59.6 ± 39.8 cm2 (25.0% ± 14.1%). Electrical isolation of abnormal substrate was achieved in 5 of 8 (62.5%) patients via endocardial approach alone and 3 of 8 (37.5%) patients via a combination of endocardial and epicardial approach. Electrical isolation was verified by slow automaticity (5 of 8, 62.5%) or RV noncapture (3 of 8, 37.5%) during high-output pacing inside the encircled area. VTs were induced in 6 patients before ablation, and all patients were rendered noninducible after ablation. During a median follow-up of 43 months (range: 24-53 months), 7 of 8 (87.5%) patients remained free of sustained VT. CONCLUSIONS Electrical isolation of RVFW is feasible and can be the option in ARVC patients with extensive abnormal substrate.
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Affiliation(s)
- Nan Wu
- Gusu School, Nanjing Medical University, Suzhou, China
| | - Hongwu Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weizhu Ju
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mingfang Li
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kai Gu
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zidun Wang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hailei Liu
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiaojiao Shi
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaohong Jiang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chang Cui
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Cheng Cai
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Gang Yang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Minglong Chen
- Gusu School, Nanjing Medical University, Suzhou, China; The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Rossi P, Cauti FM, Niscola M, Magnocavallo M, Polselli M, Capone S, Della Rocca DG, Rodriguez-Garrido J, Piccirillo G, Anguera I, Dallaglio P, Bianchi S. Ventricular Electrograms Duration Map to Detect Ventricular Arrhythmia Substrate: the VEDUM Project Study. Circ Arrhythm Electrophysiol 2023; 16:447-455. [PMID: 37485678 PMCID: PMC10786440 DOI: 10.1161/circep.122.011729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/16/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The analysis of the wave-front activation patterns is crucial for the comprehension and treatment of ventricular tachycardia (VT). The ventricular electrograms duration map (VEDUM) is a potential method to identify areas (VEDUM area) with slow and inhomogeneous activation. There is no available data on the characteristics and the arrhythmogenic role of VEDUM areas identified during sinus/paced rhythm. METHODS Patients referred for VT ablation were enrolled at 3 different centers. VEDUM maps during sinus/paced rhythm as well as substrate and functional maps were created; activation mapping was performed for all hemodynamically tolerated VT. RESULTS Thirty-two patients (mean age:70.1±9.4 years; males 93.8%) were enrolled. The VEDUM approach was achieved in all patients and the mean size of the VEDUM area was 12.1±6.9 cm2 (interquartile range, 7.8-14.9 cm2). A significative difference was observed between the electrogram duration in the VEDUM area and the normal tissue (163.7 ms [interquartile range, 142.3-199.2 ms]; versus 65.5 ms [interquartile range, 59.5-76.2 ms]; P<0.001). The VEDUM area was visualized in a dense scar (<0.5 mV) in 19 (59.4%) patients. A deceleration zone and late potentials were recorded inside the VEDUM area in 56.3% and 81.3%, respectively. When a complete VT activation mapping was available, the isthmus projected in the VEDUM area in 93.5% of patients; 8 of them had multiple VTs mapped and in the 87.5% all VT isthmuses were included in the VEDUM area. CONCLUSIONS VEDUM maps allow the identification of discrete areas of inhomogeneous and slow conduction. They represent a potential target for VT ablation, including patients with multiple morphologies.
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Affiliation(s)
- Pietro Rossi
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy (P.R., F.M.C., M.M., M.P., S.C., S.B.)
| | - Filippo Maria Cauti
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy (P.R., F.M.C., M.M., M.P., S.C., S.B.)
| | - Marta Niscola
- Abbott Medical Italy, Sesto San Giovanni, Milan, Italy (M.N.)
| | - Michele Magnocavallo
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy (P.R., F.M.C., M.M., M.P., S.C., S.B.)
| | - Marco Polselli
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy (P.R., F.M.C., M.M., M.P., S.C., S.B.)
| | - Silvia Capone
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy (P.R., F.M.C., M.M., M.P., S.C., S.B.)
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R.)
| | | | - Gianfranco Piccirillo
- University of Rome “Sapienza,” Department of Science of Internal Clinics, Anestesiologists & Cardiovasculars, Policlinico Umberto I, Rome, Italy (G.P.)
| | - Ignasi Anguera
- Arrhythmias Unit, Cardiology Department, Bellvitge University Hospital & Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Unstitute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain (I.A., P.D.)
| | - Paolo Dallaglio
- Arrhythmias Unit, Cardiology Department, Bellvitge University Hospital & Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Unstitute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain (I.A., P.D.)
| | - Stefano Bianchi
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy (P.R., F.M.C., M.M., M.P., S.C., S.B.)
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Nissan J, Sabbag A, Beinart R, Nof E. Inducibility of Multiple Ventricular Tachycardia's during a Successful Ablation Procedure Is a Marker of Ventricular Tachycardia Recurrence. J Clin Med 2023; 12:jcm12113660. [PMID: 37297854 DOI: 10.3390/jcm12113660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/14/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
Even after a successful ventricular tachycardia ablation (VTA), some patients have recurrent ventricular tachycardia (VT) during their follow-up. We assessed the long-term predictors of recurrent VT after having a successful VTA. The patients who underwent a successful VTA (defined as the non-inducibility of any VT at the procedure's end) in 2014-2021 at our center in Israel were retrospectively analyzed. A total of 111 successful VTAs were evaluated. Out of them, 31 (27.9%) had a recurrent event of VT after the procedure during a median follow-up time of 264 days. The mean left ventricular ejection fraction (LVEF) was significantly lower among patients with recurrent VT events (28.9 ± 12.67 vs. 23.53 ± 12.224, p = 0.048). A high number of induced VTs (>two) during the procedure was found to be a significant predictor of VT recurrence (24.69% vs. 56.67%, 20 vs. 17, p = 0.002). In a multivariate analysis, a lower LVEF (HR, 0.964; p = 0.037) and a high number of induced VTs (HR, 2.15; p = 0.039) were independent predictors of arrhythmia recurrence. The inducibility of more than two VTs during a VTA procedure remains a predictor of VT recurrence even after a successful VT ablation. This group of patients remains at high risk for VT and should be followed up with and treated more vigorously.
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Affiliation(s)
- Johnatan Nissan
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Avi Sabbag
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Roy Beinart
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Eyal Nof
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Ramat Gan 52621, Israel
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Aboud AA, Davogustto G, Adeola O, Richardson TD, Tokutake K, Michaud GF, Stevenson WG, Kanagasundram A. Substrate Mapping Alters Ventricular Tachycardia Inducibility. Circ Arrhythm Electrophysiol 2023; 16:e010889. [PMID: 36602818 DOI: 10.1161/circep.122.010889] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Initiation of ventricular tachycardia (VT) by programmed electrical stimulation (PES) has an important role to allow mapping and assess ablation end points. We hypothesized that substrate mapping may alter VT inducibility by mechanical bumping of critical sites. METHODS Subjects with left ventricular scar-related VT that was inducible by PES who were undergoing ablation were included. PES was repeated after substrate mapping (Group I) or after time under sedation/anesthesia during which additional imaging and transeptal puncture were performed without substrate mapping (Group II). The response to the second PES was categorized as type I if the same VT was induced, type II if a different VT was induced, and type III if VT was not inducible. RESULTS Twenty-eight patients (median age 66 years, 61% ischemic cardiomyopathy), 14 in Group I and 14 in Group II, were included. Age, time between initial and second PES, type of cardiomyopathy, ejection fraction, and anesthesia methods were not different between the 2 groups. Initial VT cycle length, however, was shorter in Group I (305 millisecond [range, 235-600] versus 350 millisecond [range, 235-600], P=0.016). Also, Group I required more extrastimuli to induce VT in PES 1 (2 [1-4] versus 2 [1-3], P=0.022). In Group I, following substrate mapping, the second PES induced the same VT in 3 patients (21%), a different VT in 9 (64%), and no VT in 2 (14%) patients. In contrast, in Group II the same VT was induced in 10 (71%) patients, a different VT in 3 (21%) and no VT in 1 (7%) patient (P=0.017). CONCLUSIONS Mechanical effects of substrate mapping commonly alter inducibility of VT. This has important implications for catheter ablation procedure planning and acute assessment of outcome and can potentially account for some recurrent VTs that are not recognized at the time of the procedure.
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Affiliation(s)
- Asad A Aboud
- Ascension Saint Thomas Heart Center, Nashville, TN (A.A.A.)
| | - Giovanni Davogustto
- Vanderbilt Heart and Vascular Institute, Nashville, TN (G.D., T.D.R., K.T., G.F.M., W.G.S., A.K.)
| | - Oluwaseun Adeola
- Methodist Hospital - Cardiology Clinic of San Antonio, TN (O.A.)
| | - Travis D Richardson
- Vanderbilt Heart and Vascular Institute, Nashville, TN (G.D., T.D.R., K.T., G.F.M., W.G.S., A.K.)
| | - Kenichi Tokutake
- Vanderbilt Heart and Vascular Institute, Nashville, TN (G.D., T.D.R., K.T., G.F.M., W.G.S., A.K.)
| | - Gregory F Michaud
- Vanderbilt Heart and Vascular Institute, Nashville, TN (G.D., T.D.R., K.T., G.F.M., W.G.S., A.K.)
| | - William G Stevenson
- Vanderbilt Heart and Vascular Institute, Nashville, TN (G.D., T.D.R., K.T., G.F.M., W.G.S., A.K.)
| | - Arvindh Kanagasundram
- Vanderbilt Heart and Vascular Institute, Nashville, TN (G.D., T.D.R., K.T., G.F.M., W.G.S., A.K.)
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Kimura Y, de Riva M, Ebert M, Glashan C, Wijnmaalen AP, Piers SR, Dekkers OM, Trines SA, Zeppenfeld K. Pleomorphic Ventricular Tachycardia in Dilated Cardiomyopathy Predicts Ventricular Tachycardia Recurrence After Ablation Independent From Cardiac Function: Comparison With Patients With Ischemic Heart Disease. Circ Arrhythm Electrophysiol 2023; 16:e010826. [PMID: 36595629 DOI: 10.1161/circep.121.010826] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND In dilated cardiomyopathy (DCM), outcome after catheter ablation of ventricular tachycardia (VT) is modest, compared with ischemic heart disease (IHD). Pleomorphic VT (PL-VT) has been associated with fibrotic remodeling and end-stage heart failure in IHD. The prognostic role of PL-VT in DCM is unknown. METHODS Consecutive IHD (2009-2016) or DCM (2008-2018) patients undergoing ablation for monomorphic VT were included. PL-VT was defined as ≥1 spontaneous change of the 12-lead VT-morphology during the same induced VT episode. Patients were followed for VT recurrence and mortality. RESULTS A total of 247 patients (86% men; 63±13 years; IHD n=152; DCM n=95) underwent ablation for monomorphic VT. PL-VT was observed in 22 and 29 patients with IHD and DCM, respectively (14% versus 31%, P=0.003). In IHD, PL-VT was associated with lower LVEF (28±9% versus 34±12%, P=0.02) and only observed in those with LVEF<40%. In contrast, in DCM, PL-VT was not related to LVEF and induced in 27% of patients with LVEF>40%. During a median follow-up of 30 months, 79 (32%) patients died (IHD 48; DCM 31; P=0.88) and 120 (49%) had VT recurrence (IHD 59; DCM 61; P<0.001). PL-VT was associated with mortality in IHD but not in DCM. In IHD, VT recurrence was independently associated with LVEF, number of induced VTs, and procedural noncomplete success. Of note, in DCM, PL-VT (HR, 2.62 [95% CI, 1.47-4.69]), pathogenic mutation (HR, 2.13 [95% CI, 1.16-3.91]), and anteroseptal VT substrate (HR, 1.75 [95% CI, 1.00-3.07]) independently predicted VT recurrence. CONCLUSIONS In IHD, PL-VT was associated with low LVEF and mortality. In DCM, PL-VT was not associated with mortality but a predictor of VT recurrence independent from LVEF. PL-VT in DCM may indicate a specific arrhythmic substrate difficult to control by current ablation techniques.
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Affiliation(s)
- Yoshitaka Kimura
- Department of Cardiology, Heart-Lung Center, Leiden University Medical Center, Leiden, The Netherlands, (Y.K., M.d.R., M.E., C.G., A.P.W., S.R.P., S.A.T., K.Z.).,Willem Einthoven Center of Arrhythmia Research and Management (Y.K., M.d.R., M.E., C.G., A.P.W., S.R.P., S.A.T., K.Z.)
| | - Marta de Riva
- Department of Cardiology, Heart-Lung Center, Leiden University Medical Center, Leiden, The Netherlands, (Y.K., M.d.R., M.E., C.G., A.P.W., S.R.P., S.A.T., K.Z.).,Willem Einthoven Center of Arrhythmia Research and Management (Y.K., M.d.R., M.E., C.G., A.P.W., S.R.P., S.A.T., K.Z.)
| | - Micaela Ebert
- Department of Cardiology, Heart-Lung Center, Leiden University Medical Center, Leiden, The Netherlands, (Y.K., M.d.R., M.E., C.G., A.P.W., S.R.P., S.A.T., K.Z.).,Willem Einthoven Center of Arrhythmia Research and Management (Y.K., M.d.R., M.E., C.G., A.P.W., S.R.P., S.A.T., K.Z.).,Heart Center, University of Leipzig, Germany (M.E.)
| | - Claire Glashan
- Department of Cardiology, Heart-Lung Center, Leiden University Medical Center, Leiden, The Netherlands, (Y.K., M.d.R., M.E., C.G., A.P.W., S.R.P., S.A.T., K.Z.).,Willem Einthoven Center of Arrhythmia Research and Management (Y.K., M.d.R., M.E., C.G., A.P.W., S.R.P., S.A.T., K.Z.)
| | - Adrianus P Wijnmaalen
- Department of Cardiology, Heart-Lung Center, Leiden University Medical Center, Leiden, The Netherlands, (Y.K., M.d.R., M.E., C.G., A.P.W., S.R.P., S.A.T., K.Z.).,Willem Einthoven Center of Arrhythmia Research and Management (Y.K., M.d.R., M.E., C.G., A.P.W., S.R.P., S.A.T., K.Z.)
| | - Sebastiaan R Piers
- Department of Cardiology, Heart-Lung Center, Leiden University Medical Center, Leiden, The Netherlands, (Y.K., M.d.R., M.E., C.G., A.P.W., S.R.P., S.A.T., K.Z.).,Willem Einthoven Center of Arrhythmia Research and Management (Y.K., M.d.R., M.E., C.G., A.P.W., S.R.P., S.A.T., K.Z.)
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Center, the Netherlands (O.M.D.)
| | - Serge A Trines
- Department of Cardiology, Heart-Lung Center, Leiden University Medical Center, Leiden, The Netherlands, (Y.K., M.d.R., M.E., C.G., A.P.W., S.R.P., S.A.T., K.Z.).,Willem Einthoven Center of Arrhythmia Research and Management (Y.K., M.d.R., M.E., C.G., A.P.W., S.R.P., S.A.T., K.Z.)
| | - Katja Zeppenfeld
- Department of Cardiology, Heart-Lung Center, Leiden University Medical Center, Leiden, The Netherlands, (Y.K., M.d.R., M.E., C.G., A.P.W., S.R.P., S.A.T., K.Z.).,Willem Einthoven Center of Arrhythmia Research and Management (Y.K., M.d.R., M.E., C.G., A.P.W., S.R.P., S.A.T., K.Z.)
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10
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Prasitlumkum N, Navaravong L, Desai A, Chewcharat P, Gandhi H, Perswani P, Vallabhajosyula S, Cheungpasitporn W, Akoum N, Jongnarangsin K, Chokesuwattanaskul R. Sex differences on outcomes of catheter ablation of ventricular tachycardia in patients with structural heart disease: A real-world systematic review and meta-analysis. Heart Rhythm O2 2022; 3:847-56. [PMID: 36588991 DOI: 10.1016/j.hroo.2022.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Sex differences have diversely affected cardiac diseases. Little is known whether these differences impact outcomes of catheter ablation of ventricular tachycardia (VT). Objectives To assess the impact of sex differences on outcomes of catheter ablation of VT. Methods Databases were searched from inception through December 2021. Effect estimates from individual studies were extracted and combined using the random-effects, generic inverse variance method of DerSimonian and Laird. The outcomes of interest included VT recurrence rates, all-cause mortality, and composite outcomes of mortality, left ventricular assistant device use, and heart transplantation following VT ablation. Results Our analysis included 22 observational studies. There were 10,206 patients, of which 12.8% were women. We found no statistical difference between sexes for VT recurrence rate (pooled hazard ratio [HR] 1.04, P = .57, I 2 = 14.9%). Similarly, there was statistical difference in neither all-cause mortality nor composite outcomes (pooled HR 0.93, P = .75, I 2 = 59.1% and pooled HR 0.9, P = .33, I 2 = 0%, respectively). There was a trend toward an increase in women undergoing VT ablation in the recent registries (P = .071). Conclusion Our contemporary analysis suggests that sex may have no impact on clinical outcomes of catheter ablation of VT in patients with structural heart disease, though women are the underrepresented. However, recent VT ablation registries have involved more women in their studies. Future studies with a higher proportion of women are encouraged to verify the current perception.
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11
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Yuyun MF, Kinlay S, Singh JP, Joseph J. Are arrhythmias the drivers of sudden cardiac death in heart failure with preserved ejection fraction? A review. ESC Heart Fail 2022; 10:1555-1569. [PMID: 36495033 DOI: 10.1002/ehf2.14248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/16/2022] [Accepted: 11/08/2022] [Indexed: 12/14/2022] Open
Abstract
In patients with heart failure with preserved ejection fraction (HFpEF), sudden cardiac death (SCD) accounts for approximately 25-30% of all-cause mortality and 40% of cardiovascular mortality in properly adjudicated large clinical trials. The mechanism of SCD in HFpEF remains unknown but thought to be driven by arrhythmic events. Apart from atrial fibrillation, which is prevalent in approximately 45% of HFpEF patients, the true burden of other cardiac arrhythmias in HFpEF remains undetermined. The incidence and risk of clinically significant advanced cardiac conduction disease with bradyarrhythmias and ventricular arrhythmias remain less known. Recommendations have been made for long-term cardiac rhythm monitoring to determine the incidence of arrhythmias and clarify mechanisms and mode of death in HFpEF patients. In animal studies, spontaneous ventricular arrhythmias and SCD are significantly elevated in HFpEF animals compared with controls without heart failure. In humans, these studies are scant, with a few published small-size studies suggesting an increased incidence of ventricular arrhythmias in HFpEF. Higher rates of clinically significant conduction disease and cardiac pacing are seen in HFpEF compared with the general population. Excepting atrial fibrillation, the predictive effect of other arrhythmias on heart failure hospitalization, all-cause mortality, and precisely SCD remains unknown. Given the high occurrence of SCD in the HFpEF population, it could potentially become a target for therapeutic interventions if driven by arrhythmias. Studies to address these knowledge gaps are urgently warranted. In this review, we have summarized data on arrhythmias and SCD in HFpEF while highlighting avenues for future research in this area.
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Affiliation(s)
- Matthew F. Yuyun
- VA Boston Healthcare System Boston MA USA
- Harvard Medical School Boston MA USA
- Boston University School of Medicine Boston MA USA
- Brigham and Women's Hospital Boston MA USA
| | - Scott Kinlay
- VA Boston Healthcare System Boston MA USA
- Harvard Medical School Boston MA USA
- Boston University School of Medicine Boston MA USA
- Brigham and Women's Hospital Boston MA USA
| | - Jagmeet P. Singh
- Harvard Medical School Boston MA USA
- Massachusetts General Hospital Boston MA USA
| | - Jacob Joseph
- VA Boston Healthcare System Boston MA USA
- Harvard Medical School Boston MA USA
- Brigham and Women's Hospital Boston MA USA
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12
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Radinovic A, Peretto G, Sgarito G, Cauti FM, Castro A, Narducci ML, Mantovan R, Scaglione M, Solimene F, Scopinaro A, Tondo C, Filippini G, Bianco E, Bonso A, Calzolari V, Ferraris F, Zardini M, Piacenti M, D'Angelo G, Bosica F, Della Bella P. Matching Ablation Endpoints to Long-Term Outcome: The Prospective Multicenter Italian Ventricular Tachycardia Ablation Registry. JACC Clin Electrophysiol 2022:S2405-500X(22)01046-5. [PMID: 36752462 DOI: 10.1016/j.jacep.2022.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/06/2022] [Accepted: 10/19/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Multicenter ventricular tachycardia (VT) ablation studies have shown poorer outcomes compared with single-center experiences. This difference could be related to heterogeneous mapping and ablation strategies. OBJECTIVES This study evaluated a homogenous simplified catheter ablation strategy for different substrates and compared the results with those of a single referral center. METHODS This was a multicenter prospective VT ablation registry of patients with the following 4 causes of VT: previous myocardial infarction; previous myocarditis; arrhythmogenic right ventricular dysplasia; or idiopathic dilated cardiomyopathy. The procedural protocol included precise mapping and ablation steps with the combined endpoint of late potential (LP) abolition and noninducibility of VT. The long-term primary efficacy endpoint was freedom from VT. RESULTS A total of 309 patients were enrolled. LPs were present in 70% of patients and were abolished in 83%. At the end of the procedure 74% of LPs were noninducible. The primary combined endpoint of LP abolition and noninducibility was achieved in 64% of patients with LPs at baseline. Freedom from VT at 12 months was observed in 67% of patients. In the overall study group, VT inducibility was the only predictor of freedom from VT (P = 0.013). In patients with LPs, the VT recurrence rate was lower both for patients with complete LP abolition (P = 0.040) and for patients meeting the composite endpoint (P = 0.035). CONCLUSIONS A standardized VT mapping and ablation technique reproduced the procedural outcomes of a single referral center in a multicenter prospective study. LP abolition and noninducibility were effective in reducing VT recurrences in patients with 4 causes of cardiomyopathy. (Ventricular Tachycardia Ablation Registry; NCT03649022).
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Affiliation(s)
- Andrea Radinovic
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Giovanni Peretto
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | | | | | - Antonello Castro
- Cardiology unit Pertini Hospital- Azienda USL Roma B, Rome, Italy
| | | | | | | | | | - Alice Scopinaro
- Alessandria Hospital - SS. Antonio, Biagio, Cesare Arrigo, Alessandria, Italy
| | - Claudio Tondo
- Heart Rhythm Center, Centro Cardiologico Monzino, IRCCS Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche Università degli Studi di Miano, Milan, Italy
| | | | | | | | - Vittorio Calzolari
- Electrophysiology, Division of Cardiology, Neuro-Cardio-Vascular Department, Hospital of Treviso, ULSS 2 "Marca Trevigiana," Treviso, Italy
| | | | - Marco Zardini
- Cardiac Electrophysiology Section, Zenda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Marcello Piacenti
- CNR - Area della Ricerca di Pisa Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Giuseppe D'Angelo
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Francesco Bosica
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Paolo Della Bella
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
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13
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Zachariah D, Nakajima K, Limite LR, Zweiker D, Spartalis M, Zirolia D, Musto M, D'Angelo G, Paglino G, Baratto F, Cireddu M, Bisceglia C, Radinovic A, Marzi A, Sala S, Peretto G, Vergara P, Gulletta S, Mazzone P, Della Bella P, Frontera A. Significance of abnormal and late ventricular signals in ventricular tachycardia ablation of ischemic and nonischemic cardiomyopathies. Heart Rhythm 2022; 19:2075-2083. [PMID: 35964871 DOI: 10.1016/j.hrthm.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Abnormal ventricular signals (AVS) are the cornerstone of substrate-based ventricular tachycardia (VT) ablation in sinus rhythm. Signal characterization of AVS in ischemic and nonischemic cardiomyopathies has never been performed. OBJECTIVE The purpose of this study was to describe ventricular signal abnormalities in 3 different pathologies and examine their association with the diastolic component of VT circuits. METHODS A total of 45 patients (15 ischemic cardiomyopathy [ICM], 15 arrhythmogenic cardiomyopathy [ACM], 15 dilated cardiomyopathy [DCM]) who had undergone VT ablation with >50% of the diastolic pathway of the VT circuit recorded were studied. AVS were classified into late potentials (LPs) and continuous fractionated ventricular signals (CFVS), and their characteristics and correlation with the diastolic pathway of VT circuits were analyzed. RESULTS Seventy-five VT circuits were analyzed. Bipolar scars were greatest in ICM endocardially (53 cm2 ICM vs 36 cm2 ACM vs 25 cm2 DCM; P = .010) and in ACM epicardially (98 cm2 ACM vs 25 cm2 ICM vs 24 cm2 DCM; P = .005). Location of the VT diastolic interval coincided with AVS location in 54% of VTs in ICM, 89% in ACM, and 72% in DCM (P = .036). There was a trend toward a greater association of diastolic intervals coinciding with LPs than with CFVS (78% vs 57%; P = .052) (69% diastolic intervals in ICM coincided with LPs, 33% with CFVS; P = .063). All patients (100%) with CFVS in ACM had VT diastolic components arising from CFVS (33% ICM, 64% DCM; P = .049). Positive predictive value for LPs vs CFVS was 77.8% vs 56.7%, and sensitivity was 67.3% vs 32.7%, respectively. CONCLUSION The nature of abnormal signals in different cardiomyopathies reflects underlying pathology. LPs rather than CFVS seem to be more linked to diastolic components of VT circuits, especially in ICM. LPs have greater sensitivity and specificity for VT; however, CFVS may be of more relevance in ACM.
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Affiliation(s)
- Donah Zachariah
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy; Department of Cardiology, University Hospitals of North Midlands, Stoke on Trent, United Kingdom.
| | | | | | - David Zweiker
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Michael Spartalis
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Davide Zirolia
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Martina Musto
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giuseppe D'Angelo
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Gabriele Paglino
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Francesca Baratto
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Manuela Cireddu
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Andrea Radinovic
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alessandra Marzi
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Simone Sala
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giovanni Peretto
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Pasquale Vergara
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Simone Gulletta
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Patrizio Mazzone
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Paolo Della Bella
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Antonio Frontera
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
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14
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Nakasone K, Fukuzawa K, Kiuchi K, Takami M, Sakai J, Nakamura T, Yatomi A, Sonoda Y, Takahara H, Yamamoto K, Suzuki Y, Tani K, Iwai H, Nakanishi Y, Hirata K. Predictors of recurrence in patients without non-inducibility of ventricular tachycardia at the end of ablation. J Arrhythm 2022; 39:52-60. [PMID: 36733320 PMCID: PMC9885314 DOI: 10.1002/joa3.12796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/26/2022] [Accepted: 11/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background Ventricular tachycardia (VT) non-inducibility at the end of ablation is associated with a less likely VT recurrence. However, it is not clear whether we should use VT non-inducibility as a routine end point of VT ablation. The aim of this study was to evaluate VT recurrence in patients in whom VT non-inducibility was not achieved at the end of the radiofrequency (RF) ablation and the factors attributing to the VT recurrence. Methods We analyzed that 62 patients in whom VT non-inducibility was not achieved at the end of the RF ablation were studied. Results Over 2 years, 22 (35%) of the cases had VT recurrences. A multivariate analysis showed that an LVEF ≥35% (HR: 0.19; 95% CI: 0.06-0.49; p < .01) and elimination of the clinical VT as an acute ablation efficacy (HR: 0.23; 95% CI: 0.04-0.81; p = .02) were independent predictors of fewer VT recurrences. RF ablation was associated with a 91.1% reduction in VT episodes. Conclusion Even if VT non-inducibility was not achieved, patients with an LVEF ≥35% or in whom the clinical VT could be eliminated might be prevented from having VT recurrences. The validity of the VT non-inducibility of any VT should be evaluated considering each patient's background and the results of the procedure.
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Affiliation(s)
- Kazutaka Nakasone
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Koji Fukuzawa
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan,Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Kunihiko Kiuchi
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan,Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Mitsuru Takami
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Jun Sakai
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Toshihiro Nakamura
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Atsusuke Yatomi
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Yusuke Sonoda
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Hiroyuki Takahara
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Kyoko Yamamoto
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Yuya Suzuki
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Ken‐ichi Tani
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Hidehiro Iwai
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Yusuke Nakanishi
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Ken‐ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
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