Abstract 13902: Endocardial Homogeneization of the Scar Improves the Long-term Outcomes of Catheter Ablation of Ventricular Arrhythmias in Patients With Ischemic Cardiomyopathy and Cardiac Bypass Surgery
Background: Catheter ablation of ventricular arrhythmias (VA) has shown moderate success rate at long term follow-up in patients with ischemic cardiomyopathy and previous cardiac bypass surgery (CABG).
Objective: We compared two different substrate approaches for the treatment of these arrhythmias.
Methods: 104 consecutive patients with ischemic cardiomyopathy and with previous CABG underwent catheter ablation for VA. Patients were treated either with limited substrate ablation confined to the endocardial isthmus responsible for the VT (Group 1, n= 52, 82% male, 62±8 years, LVEF 27±5%), or underwent endocardial ablation of all abnormal potentials within the scar in sinus rhythm (homogenization of the scar, Group 2, n=52, 80% male, 61±10 years, LVEF 26±8%).
Results: Baseline characteristics were not different between groups. During a mean follow-up of 22±8 months, the VAs recurrence from any VTs was 56% (29/52 pts) in Group 1 and 25% (13/52 pts) in Group 2 (log-rank p<0.001) (figure). In addition, a higher number of patients were off AADs in group 2 vs group 1 [9/13 (70%) vs. 8/29 (27%), p <0.001]. Two patients, one for each group, died at follow up.
Conclusions: Ablation of ventricular arrhythmias in ischemic patients with previous CABG using endocardial homogenization of the scar significantly increases the freedom from any VTs at the long term follow up.
- © 2013 by American Heart Association, Inc.