(Circulation. 1997;96:3499-3508.)
© 1997 American Heart Association, Inc.
Articles |
Radiofrequency Catheter Ablation of Postinfarction Ventricular Tachycardia
Long-term Success and the Significance of Inducible Nonclinical Arrhythmias
From Temple University School of Medicine, Philadelphia, Pa.
Correspondence to Steven A. Rothman, MD, Cardiology Section, Temple University School of Medicine, Parkinson Pavilion, Room 908, 3401 N Broad St, Philadelphia, PA 19140. E-mail sarcer{at}astro.ocis.temple.edu
Background Radiofrequency (RF) catheter ablation is effective therapy for monomorphic ventricular tachycardia (VT) in patients without structural heart disease. In patients with postinfarction VT; however, this procedure has been used predominantly as adjunctive therapy, targeting only the patient's clinically documented arrhythmia. By targeting all inducible, sustained VT morphologies, we sought to determine the utility of RF catheter ablation as a primary cure in patients who present with hemodynamically tolerated VT.
Methods and Results RF ablation was attempted in 35 patients with a previous myocardial infarction and recurrent, hemodynamically tolerated VT. A mean of 3.9±2.7 VTs were induced per patient (range, 1 to 10). The clinically documented arrhythmia was successfully ablated in 30 of 35 patients (86%), and on follow-up electrophysiological testing, 11 patients had no inducible VT and were discharged without other therapy. Nineteen patients had inducible "nonclinical" arrhythmias on follow-up testing, and the majority underwent cardiac defibrillator implantation. Freedom from recurrent arrhythmias, including sudden death, was 91% in patients without inducible VT and 53% in patients with persistently inducible "nonclinical" arrhythmias (P<.05; mean follow-up, 17±12 and 12±11 months, respectively).
Conclusions In patients with well-tolerated VT, RF catheter ablation may be useful as a primary cure if no other ventricular arrhythmias are inducible on follow-up testing. Ablation of all hemodynamically tolerated arrhythmias should be attempted in patients with multiple inducible VT morphologies because of the high rate of recurrence of unablated VTs in these patients.
Key Words: tachyarrhythmias • catheter ablation • tachycardia • coronary disease
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