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Epicardial ventricular tachycardia in ischemic cardiomyopathy: Prevalence, electrophysiological characteristics, and long-term ablation outcomes.

Abstract：

INTRODUCTION:The characteristics of the epicardial (EPI) substrate responsible for ventricular tachycardia (VT) in ischemic cardiomyopathy (ICM) are undefined, and data on the long-term outcomes of EPI catheter ablation limited. We evaluated the prevalence, electrophysiologic features, and outcomes of catheter ablation of EPI VT in ICM. METHODS AND RESULTS:From December 2010 to June 2013, a total of 13 of 93 (14%) patients with ICM underwent catheter ablation at our institution and had conclusive evidence of critical EPI substrate demonstrated to participate in VT with activation, entrainment and/or pace mapping during sinus rhythm (two other patients underwent EPI mapping but had no optimal ablation targets). The electrophysiologic substrate characteristics and activation/entrainment mapping data were compared with a reference group of ICM patients without evidence of critical EPI substrate (N = 44), defined as a complete procedural success (noninducibility of any VT at programmed stimulation) after endocardial (ENDO)-only ablation. Patients with failed EPI access (N = 2) or history of cardiac surgery (N = 92) were excluded from the study. All 13 patients had evidence of abnormal EPI substrate with fractionated/late/split electrograms and low-bipolar voltage areas. The critical VT ablation sites were all located within the EPI bipolar "dense" scar (<1.0 mV) opposite the ENDO bipolar scar in 77% of cases and extending beyond the ENDO bipolar scar (within the ENDO unipolar low-voltage area) in the remaining patients. Compared with the reference ENDO-only group, patients with EPI VT had a smaller ENDO bipolar scar area, 54.0 (37.1-84) vs 86.7 (55.6-112) cm2 ; P = 0.0159, with a similar extent of ENDO unipolar low voltage. No other substrate characteristics or location differed between the two groups. After 35.2 ± 24.2 months of follow-up, VT-free survival was 73% in patients with EPI VT compared with 66% in the ENDO-only group (log-rank P = 0.56). CONCLUSIONS:The presence of the critical EPI substrate responsible for VT can be demonstrated in at least 14% of patients with ICM. The majority of EPI critical ablation sites are distributed opposite the ENDO bipolar scar area and catheter ablation is effective in achieving long-term arrhythmia control.

journal_name

J Cardiovasc Electrophysiol

journal_title

Journal of cardiovascular electrophysiology

authors

Hayashi T,Liang JJ,Muser D,Shirai Y,Enriquez A,Garcia FC,Supple GE,Schaller RD,Frankel DS,Lin D,Nazarian S,Zado ES,Arkles JS,Dixit S,Callans DJ,Marchlinski FE,Santangeli P

doi

10.1111/jce.13739

subject

Has Abstract

pub_date

2018-11-01 00:00:00

pages

1530-1539

issue

eissn

1045-3873

issn

1540-8167

journal_volume

pub_type

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Epicardial ventricular tachycardia in ischemic cardiomyopathy: Prevalence, electrophysiological characteristics, and long-term ablation outcomes.