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From the Cardiovascular Division, Department of Medicine, Brigham and
Women's Hospital, Harvard Medical School, Boston, Mass (W.G.S., P.L.F.,
L.A.S.); the Division of Cardiology, Department of Medicine, Wadsworth VA
Medical Center, UCLA School of Medicine, Los Angeles, Calif (P.T.S); and the
Division of Cardiology, Department of Medicine, Hospital of the University of
Pennsylvania, Philadelphia (D.K., B.P.). Dr Saxon is now at the Division of
Cardiology, Department of Medicine, University of California at San Francisco.
Correspondence to William G. Stevenson, MD, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. E-mail wgstevenso{at}bics.bwh.harvard.edu
Background—Patients with
ventricular tachycardia (VT) after myocardial
infarction often have multiple morphologies of inducible VT, which
complicates mapping and is viewed by some as a relative
contraindication to ablation. Attempting to identify and target a
single "clinical" VT is often limited by inability to obtain
12-lead ECGs of VTs that are terminated emergently or by
defibrillators. This study assesses the feasibility of ablation in
patients selected without regard to the presence of multiple VTs by
targeting all VTs that allow mapping.
Methods and Results—Radiofrequency catheter ablation targeting
all inducible monomorphic VTs that allowed mapping was performed in 52
patients with prior myocardial infarction. Antiarrhythmic drug therapy
had failed in 41 (79%) patients including amiodarone in 36
(69%) patients. An average of 3.6±2 morphologies of VT were induced
per patient. More than 1 ablation session was required in 16 (31%)
patients. Complications occurred in 5 (10%) patients, including 1
(2%) death caused by acute myocardial infarction. During follow-up
59% of patients continued to receive amiodarone; 23 (45%) had
implantable defibrillators. During a mean follow-up of 18±15 months
(range 0 to 51 months) 1 patient died suddenly, 2 died from
uncontrollable VT, and 5 died from heart failure. Three-year survival
rate was 70±10%, and rate for risk of VT recurrence was
33±7%.
Conclusions—Radiofrequency catheter ablation controls VT that is
sufficiently stable to allow mapping in 67% of patients despite
failure of antiarrhythmic drug therapy and multiple inducible VTs.
However, ablation was largely adjunctive to amiodarone and
defibrillators in this referral population.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Radiofrequency Catheter Ablation of Ventricular Tachycardia After Myocardial Infarction
Key Words: catheter ablation • tachycardia • myocardial infarction
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