This Article Full Text Full Text (PDF) All Versions of this Article: 116/18/2005    most recent CIRCULATIONAHA.107.703157v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Eckart, R. E. Articles by Stevenson, W. G. Search for Related Content PubMed PubMed Citation Articles by Eckart, R. E. Articles by Stevenson, W. G. Related Collections Electrophysiology Ablation/ICD/surgery CV surgery: valvular disease Arrhythmias, clinical electrophysiology, drugs

(Circulation. 2007;116:2005-2011.)
© 2007 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Sustained Ventricular Tachycardia Associated With Corrective Valve Surgery

Robert E. Eckart, DO; Tomasz W. Hruczkowski, MD; Usha B. Tedrow, MD; Bruce A. Koplan, MD; Laurence M. Epstein, MD; William G. Stevenson, MD

From Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass.

Correspondence to Robert E. Eckart, MAJ MC, US Army, Arrhythmia Service (Cardiology), 3851 Roger Brooke Dr, Brooke Army Medical Center (Attn: MCHE-MDC), San Antonio, TX 78234. E-mail robert.eckart{at}us.army.mil

Received March 21, 2007; accepted July 19, 2007.

Background— The causes of sustained monomorphic ventricular tachycardia (VT) after cardiac valve surgeries have not been studied extensively, although bundle-branch reentry has been reported.

Methods and Results— Records of 496 patients referred for electrophysiology study and catheter ablation of recurrent VT were reviewed. Twenty patients (4%) had VT after aortic or mitral valve surgery in the absence of known myocardial infarction. The median age was 53 years, and the median ejection fraction was 45%. In 4 patients, VT occurred early after surgery, and electrophysiology study was performed 3 to 10 days later. In the remaining patients, electrophysiology study was performed a median of 12 years (interquartile range 5 to 15 years) after surgery. Sustained VT was inducible in 17 patients. VT was attributed to scar-related reentry in 14 patients (70%) and to bundle-branch reentry in 2 (10%). Multiple VTs were present in 9 of 14 patients with scar-related reentry. A total of 42 induced VTs were targeted for ablation. Of the 14 patients with scar-related reentry, 9 (64%) had periannular scar, and 10 (71%) had an identifiable endocardial circuit isthmus. Ablation abolished 41 (98%) of the 42 targeted VTs. At a median follow-up of 2.1 years, 3 deaths occurred 8 to 14 months after ablation. One patient with incessant VT early after valve surgery suffered a stroke with residual hemianopsia. Of the 20 patients, 3 required repeat ablation after recurrence, and 2 of these who were not inducible during electrophysiology study had clinical recurrence that necessitated ablation.

Conclusions— Sustained VT after valve surgery appears to be bimodal in presentation, occurring either early after surgery or years later. In this referral population, reentry in a region of scar is more common than bundle-branch reentry. Catheter ablation can be successful.

---

 

CLINICAL PERSPECTIVE

This article has been cited by other articles:

				Y. Mizusawa, H. Sakurada, M. Nishizaki, A. Ueda-Tatsumoto, S. Fukamizu, and M. Hiraoka Characteristics of bundle branch reentrant ventricular tachycardia with a right bundle branch block configuration: feasibility of atrial pacing Europace, September 1, 2009; 11(9): 1208 - 1213. [Abstract] [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. E. Marchlinski Ventricular Tachycardia Ablation: Moving Beyond Treatment of Last Resort Circ Arrhythm Electrophysiol, August 1, 2008; 1(3): 147 - 149. [Full Text] [PDF]

				F. Sacher, U. B. Tedrow, M. E. Field, J.-M. Raymond, B. A. Koplan, L. M. Epstein, and W. G. Stevenson Ventricular Tachycardia Ablation: Evolution of Patients and Procedures Over 8 Years Circ Arrhythm Electrophysiol, August 1, 2008; 1(3): 153 - 161. [Abstract] [Full Text] [PDF]

				F. E. Marchlinski Perivalvular Fibrosis and Monomorphic Ventricular Tachycardia: Toward a Unifying Hypothesis in Nonischemic Cardiomyopathy Circulation, October 30, 2007; 116(18): 1998 - 2001. [Full Text] [PDF]