Abstract 17371: Endo-Epicardial Homogeneization of the Scar versus Limited Endocardial Substrate Ablation for the Treatment of Electrical Storms in Patients With Ischemic Cardyomiopathy.
Introduction: Catheter ablation of electrical storms for ventricular arrhythmias (VA) has shown moderate long-term efficacy in patients with ischemic cardiomyopathy. We investigated the impact on recurrences of two different substrate approaches for the treatment of these arrhythmias.
Methods: 82 consecutive patients (81% male, 62±13 years) with ischemic cardiomyopathy underwent VA ablations. Patients were treated either by confining the radiofrequency lesions to the endocardial surface with limited substrate ablation (group 1, n= 49), or underwent endocardial and epicardial ablation of all potentials within the scar (homogenization of the scar, group 2, n=33). In the latter group epicardial access and ablation was performed in 33% (11) of the patients.
Results: Mean EF was 27±5. During a mean follow-up of 21±10 months, no deaths occurred. The VT recurrence rate of any VTs was 41% (20/49 pts) in group 1 and 18.2% (6/33 pts) in group 2 (log-rank p=0.034). The figure shows the Kaplan-Meier estimates of any VT recurrence.
Conclusions: Our study demonstrates that ablation using endo-epicardial homogenization of the scar significantly increases freedom from VAs in ischemic cardiomyopathy patients.
- © 2010 by American Heart Association, Inc.