doi: 10.1161/CIRCULATIONAHA.108.191131
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(Circulation. 2008;118:2667-2668.)
© 2008 American Heart Association, Inc.
Clinical Summaries
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
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Irrigated Radiofrequency Catheter Ablation Guided by Electroanatomic Mapping for Recurrent Ventricular Tachycardia After Myocardial Infarction: The Multicenter Thermocool Ventricular Tachycardia Ablation Trial |
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Although implantable cardioverter-defibrillators reduce death resulting from ventricular tachycardia (VT), episodes of VT decrease quality of life and predict increased rates of death. Antiarrhythmic drugs are often used to suppress VT but have potential adverse effects and relatively poor efficacy. In the largest study to date of catheter ablation for recurrent monomorphic VT caused by coronary artery disease, we prospectively evaluated radiofrequency catheter ablation using an irrigated catheter combined with an electroanatomic mapping system to facilitate substrate mapping during sinus rhythm. In contrast to prior studies, patients with hemodynamically unstable, unmappable VTs and multiple VTs were included because these VTs are often present in patients with ICDs. Despite a population with severely depressed ventricular function and drug-refractory, frequent VT, ablation abolished recurrent VT in approximately half of the patients. Of those in whom VT recurred, the frequency of episodes was substantially reduced for many, allowing reduction or withdrawal of antiarrhythmic drugs for some patients. The procedure mortality rate was 3%, and there were no strokes. The 1-year mortality rate was 18%, with ventricular arrhythmias and heart failure accounting for >70% of deaths. The present study demonstrates that patients with recurrent sustained VT and coronary artery disease are a high-risk population with substantial death risk despite implantable cardioverter-defibrillators. Catheter ablation is a reasonable option to reduce VT episodes, even if multiple and unmappable VTs are present. See p 2773.
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Changes in Hospital Mortality Rates in 425 Patients With Acute ST-Elevation Myocardial Infarction and Cardiac Rupture Over a 30-Year Period |
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The incidence of cardiac rupture and its rate of death were investigated in 6678 consecutive ST-elevation myocardial infarction patients during a
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