Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 60, Issue 2, Pages 132-141Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2012.03.044
Keywords
catheter ablation; electrical storm; electrophysiology; epicardial; irrigated tip catheter; ischemic cardiomyopathy; mapping; myocardial infarction; scar; ventricular tachycardia
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Funding
- Program for New Century Excellent Talents in University [NCET-09-0376]
- National Natural Science Foundation [NSFC-30700297, 30973601]
- Scientific Research Foundation for the Returned Overseas Chinese Scholars [SFR ROCS 2008-101]
- St. Jude Medical
- Biotronik
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Objectives This study investigated the impact on recurrences of 2 different substrate approaches for the treatment of these arrhythmias. Background Catheter ablation of electrical storms (ES) for ventricular arrhythmias (VAs) has shown moderate long-term efficacy in patients with ischemic cardiomyopathy. Methods Ninety-two consecutive patients (81% male, age 62 +/- 13 years) with ischemic cardiomyopathy and ES underwent catheter ablation. Patients were treated either by confining the radiofrequency lesions to the endocardial surface with limited substrate ablation (Group 1, n = 49) or underwent endocardial and epicardial ablation of abnormal potentials within the scar (homogenization of the scar, Group 2, n = 43). Epicardial access was obtained in all Group 2 patients, whereas epicardial ablation was performed in 33% (14) of these patients. Results Mean ejection fraction was 27 +/- 5. During a mean follow-up of 25 +/- 10 months, the VAs recurrence rate of any ventricular tachycardia (VTs) was 47% (23 of 49 patients) in Group 1 and 19% (8 of 43 patients) in Group 2 (log-rank p = 0.006). One patient in Group 1 and 1 patient in Group 2 died at follow-up for noncardiac reasons. Conclusions Our study demonstrates that ablation using endo-epicardial homogenization of the scar significantly increases freedom from VAs in ischemic cardiomyopathy patients. (J Am Coll Cardiol 2012;60:132-41) (C) 2012 by the American College of Cardiology Foundation
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