Advertisement

Long-term clinical outcome of patients with prior myocardial infarction after palliative radiofrequency catheter ablation for frequent ventricular tachycardia

      Abstract

      Patients with coronary artery disease and hemodynamically tolerated, highly frequent, sustained monomorphic ventricular tachycardia (VT) may undergo radiofrequency catheter ablation (RFCA) for elimination of ≥1 morphologically distinct VTs. The purpose of this study was to evaluate the long-term clinical benefit following RFCA as a palliative treatment of highly frequent or incessant ischemic VT. Fifty-five patients underwent RFCA of 62 VTs. The target VT was successfully ablated in 82% of patients. Complication and perioperative mortality rates were 7.2% and 1.8%, respectively. At 5 years, total mortality was 51% and probability of freedom from all ventricular tachyarrhythmias was 28%. All patients had highly frequent or incessant drug-refractory VT before RFCA. Clinical benefit was defined as either freedom from all ventricular tachyarrhythmias, or a reduction in frequency of recurrence from >1 episode per month before RFCA to ≤1 episode per year of any ventricular tachyarrhythmia, including all appropriate implantable cardioverter defibrillator (ICD) therapies. By this definition, 54% of the patients continued to benefit from RFCA at 5 years. Of 19 variables analyzed with a Cox univariate model, only the presence of a left ventricular aneurysm and a previously implanted ICD were predictive of any ventricular arrhythmia recurrence. However, at 5 years over half of the surviving patients still continued to benefit from RFCA of their clinical VT. Because the overall rate of any ventricular tachyarrhythmia occurrence during follow-up is high, additional protection, such as an ICD, is required.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Morady F.
        • Harvey M.
        • Kalbfleisch S.J.
        • El-Atassi R.
        • Calkins H.
        • Langberg J.J.
        Radiofrequency catheter ablation of ventricular tachycardia in patients with coronary artery disease.
        Circulation. 1993; 87: 363-372
        • Stevenson W.G.
        • Khan H.
        • Sager P.
        • Sacon L.A.
        • Middlekauff H.R.
        • Natterson P.D.
        • Wiener I.
        Identification of reentry circuit sites during catheter mapping and radiofrequency ablation of ventricular tachycardia late after myocardial infarction.
        Circulation. 1993; 88: 1647-1670
        • Kim Y.H.
        • Sosa-Suarez G.
        • Trouton T.G.
        • O’Nunain S.S.
        • Osswald S.
        • McGovern B.A.
        • Ruskin J.N.
        • Garan H.
        Treatment of ventricular tachycardia by transcatheter radiofrequency ablation in patients with ischemic heart disease.
        Circulation. 1994; 89: 1094-1102
        • Gonska B.D.
        • Cao K.
        • Schaumann A.
        • Dorszewski A.
        • von zur Muhlen F.
        • Kreuzer H.
        Catheter ablation of ventricular tachycardia in 136 patients with coronary artery disease.
        J Am Coll Cardiol. 1994; 24: 1506-1514
        • Strickberger S.A.
        • Man K.C.
        • Daoud E.G.
        • Goyal R.
        • Brinkman K.
        • Hasse C.
        • Bogun F.
        • Knight B.P.
        • Weiss R.
        • Bahu M.
        • Morady F.
        A prospective evaluation of catheter ablation of ventricular tachycardia as adjuvant therapy in patients with coronary artery disease and an implantable cardioverter-defibrillator.
        Circulation. 1997; 96: 1525-1531
        • Cao K.
        • Gonska B.D.
        Catheter ablation of incessant ventricular tachycardia.
        Eur Heart J. 1996; 17: 756-763
        • Stevenson W.G.
        • Freidman P.L.
        • Sager P.T.
        • Saxon L.A.
        • Kocovic D.
        • Harada T.
        • Wiener I.
        • Khan H.
        Exploring postinfarction reentrant ventricular tachycardia with entrainment mapping.
        J Am Col Cardiol. 1997; 29: 1180-1189
        • Bogun F.
        • Bahu M.
        • Knight B.P.
        • Weiss R.
        • Paladino W.
        • Harvey M.
        • Goyal R.
        • Daoud E.
        • Ching Man K.
        • Strickberger S.A.
        • Morady F.
        Comparison of effective and ineffective target sites that demonstrate concealed entrainment in patients with coronary artery disease undergoing radiofrequency ablation of ventricular tachycardia.
        Circulation. 1997; 95: 183-190
        • Stevenson W.G.
        • Friedman P.L.
        • Kocovic D.
        • Sager P.T.
        • Saxon L.A.
        • Pavri B.
        Radiofrequency catheter ablation of ventricular tachycardia after myocardial infarction.
        Circulation. 1998; 98: 308-314
        • O’Callaghan P.A.
        • Ruskin J.N.
        • McGovern B.A.
        • Garan H.
        Resetting of mid-diastolic potentials localizes successful sites for radiofrequency ablation in patients with ventricular tachycardia due to coronary artery disease.
        J Am Coll Cardiol. 1996; 27 (abstr): 76
        • Rothman S.A.
        • Hsia H.H.
        • Cossu S.F.
        • Chmielewski I.L.
        • Buxton A.E.
        • Miller J.M.
        Radiofrequency catheter ablation of postinfarction ventricular tachycardia.
        Circulation. 1997; 96: 3499-3508
        • Sarter B.H.
        • Finkle J.K.
        • Gerszten R.E.
        • Buxton A.E.
        What is the risk of sudden cardiac death in patients presenting with hemodynamically stable sustained ventricular tachycardia after myocardial infarction?.
        J Am Coll Cardiol. 1996; 28: 122-129