Published online before print December 8, 2003, doi: 10.1161/01.CIR.0000103701.30662.5C
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2003;108:3011.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Successful Catheter Ablation of Electrical Storm After Myocardial Infarction
From the Department of Cardiology (D.B., F.O., M.A., S.E., K.-H.K.), AK St. Georg, Hamburg, Germany; Department of Rhythmology (T.A., R.W.), Bad Krozingen, Germany; and the Wichita Institute for Clinical Research, Wichita, Kan (J.E.V.-M.).
Correspondence to Karl Heinz Kuck, MD, Department of Internal Medicine II, Cardiology, Allgemeines Krankenhaus St. Georg, Lohmühlenstrasse 5, 20099 Hamburg, Germany. E-mail BAE151162{at}aol.com
Received February 5, 2003; de novo received August 15, 2003; revision received September 1, 2003; accepted September 12, 2003.
Background— We report on 4 patients (aged 57 to 77 years; 3 men) who developed drug-refractory, repetitive ventricular tachyarrhythmias after acute myocardial infarction (MI). All episodes of ventricular arrhythmias were triggered by monomorphic ventricular premature beats (VPBs) with a right bundle-branch block morphology (RBBB).
Methods and Results— Left ventricular (LV) mapping was performed to attempt radiofrequency (RF) ablation of the triggering VPBs. Activation mapping of the clinical VPBs demonstrated the earliest activation in the anteromedial LV in 1 patient and in the inferomedial LV in 2 patients. Short, high-frequency, low-amplitude potentials were recorded that preceded the onset of each extrasystole by a maximum of 126 to 160 ms. At the same site, a Purkinje potential was documented that preceded the onset of the QRS complex by 23 to 26 ms during sinus rhythm. In 1 patient, only pace mapping was attempted to identify areas of interest in the LV. Six to 30 RF applications abolished all local Purkinje potentials at the site of earliest activation and/or perfect pace mapping and suppressed VPBs in all patients. No episode of ventricular tachycardia or fibrillation has recurred for 33, 14, 6, and 5 months in patients 1, 2, 3, and 4, respectively.
Conclusions— Incessant ventricular tachyarrhythmias after MI may be triggered by VPBs. RF ablation of the triggering VPBs is feasible and can prevent drug-resistant electrical storm, even after acute MI. Catheter ablation of the triggering VPBs may be used as a bailout therapy in these patients.
Key Words: fibrillation • myocardial infarction • ablation • tachycardia
This article has been cited by other articles:
 |
|
 |
|
  R. Gopinathannair, A. K. Chaudhary, D. Xing, D. Ely, W. Zheng, and J. B. Martins Angiotensin II effects on ischemic focal ventricular tachycardia are predominantly mediated through myocardial AT2 receptor Am J Physiol Heart Circ Physiol, November 1, 2009; 297(5): H1889 - H1898. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Knecht, F. Sacher, M. Wright, M. Hocini, A. Nogami, T. Arentz, B. Petit, R. Franck, C. De Chillou, D. Lamaison, et al. Long-term follow-up of idiopathic ventricular fibrillation ablation: a multicenter study. J. Am. Coll. Cardiol., August 4, 2009; 54(6): 522 - 528. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. D. Lindsay Eliminating triggers of ventricular fibrillation: the past, present, and future. J. Am. Coll. Cardiol., August 4, 2009; 54(6): 529 - 530. [Full Text] [PDF]
|
|
|
|
 |
|
 E. M. Aliot, W. G. Stevenson, J. M. Almendral-Garrote, F. Bogun, C. H. Calkins, E. Delacretaz, P. D. Bella, G. Hindricks, P. Jais, M. E. Josephson, et al. EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: Developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA) Europace, June 1, 2009; 11(6): 771 - 817. [Full Text] [PDF]
|
|
|
|
 |
|
 F. A. Atik, M. F. M. Garcia, J. M. Baggio Jr, C. N. Faber, R. B. Corso, L. F. Caneo, and A. V. Sarabanda Recurrent ventricular arrhythmia after coronary artery bypass grafting treated with radiofrequency catheter ablation. Ann. Thorac. Surg., February 1, 2009; 87(2): 631 - 633. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Eckardt, G&#x.;n. Breithardt, and S. Hohnloser CHAPTER 30 Ventricular Tachycardia and Sudden Cardiac Death ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Hirose, B. D. Stuyvers, W. Dun, H. E.D.J. ter Keurs, and P. A. Boyden Function of Ca2+ Release Channels in Purkinje Cells That Survive in the Infarcted Canine Heart: A Mechanism for Triggered Purkinje Ectopy Circ Arrhythm Electrophysiol, December 1, 2008; 1(5): 387 - 395. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. L. Sapp Venturing Into the Storm Circulation, January 29, 2008; 117(4): 456 - 457. [Full Text] [PDF]
|
|
|
|
|
|
C. Carbucicchio, M. Santamaria, N. Trevisi, G. Maccabelli, F. Giraldi, G. Fassini, S. Riva, M. Moltrasio, M. Cireddu, F. Veglia, et al. Catheter Ablation for the Treatment of Electrical Storm in Patients With Implantable Cardioverter-Defibrillators: Short- and Long-Term Outcomes in a Prospective Single-Center Study Circulation, January 29, 2008; 117(4): 462 - 469. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. G. Stevenson and K. Soejima Catheter Ablation for Ventricular Tachycardia Circulation, May 29, 2007; 115(21): 2750 - 2760. [Full Text] [PDF]
|
|
|
|
 |
|
 A. K. Gehi, D. Mehta, and J. A. Gomes Evaluation and Management of Patients After Implantable Cardioverter-Defibrillator Shock JAMA, December 20, 2006; 296(23): 2839 - 2847. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) J. Am. Coll. Cardiol., September 5, 2006; 48(5): e247 - e346. [Full Text] [PDF]
|
|
|
|
|
|
Writing Committee Members, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Europace, September 1, 2006; 8(9): 746 - 837. [Full Text] [PDF]
|
|
|
|
|
|
L. Szumowski, P. Sanders, F. Walczak, M. Hocini, P. Jais, R. Kepski, E. Szufladowicz, P. Urbanek, P. Derejko, R. Bodalski, et al. Mapping and ablation of polymorphic ventricular tachycardia after myocardial infarction J. Am. Coll. Cardiol., October 19, 2004; 44(8): 1700 - 1706. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. F. Marrouche, A. Verma, O. Wazni, R. Schweikert, D. O. Martin, W. Saliba, F. Kilicaslan, J. Cummings, J. D. Burkhardt, M. Bhargava, et al. Mode of initiation and ablation of ventricular fibrillation storms in patients with ischemic cardiomyopathy J. Am. Coll. Cardiol., May 5, 2004; 43(9): 1715 - 1720. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. P. Zipes The year in electrophysiology J. Am. Coll. Cardiol., April 7, 2004; 43(7): 1306 - 1314. [Full Text] [PDF]
|
|