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Catheter ablation of polymorphic ventricular tachycardia/fibrillation in patients with and without structural heart disease.

Abstract：

BACKGROUND:Catheter ablation for polymorphic ventricular tachycardia and ventricular fibrillation (PMVT/VF) may target triggering premature ventricular contractions (PVCs). Targeting ventricular scar has also been suggested, but data are limited. OBJECTIVE:The purpose of this study was to characterize the electrophysiological findings and ablation outcomes for patients with PMVT/VF and structural heart disease (SHD) compared to those with idiopathic VF. METHODS:Data from 32 consecutive patients (13 idiopathic VF, 19 SHD) with recurrent PMVT/VF who underwent catheter ablation were reviewed. RESULTS:A low-voltage area of myocardial scar was present in 15 of 19 patients with SHD. Sustained monomorphic ventricular tachycardia (SMVT) associated with scar was inducible and targeted in 8, 3 of whom had previous SMVT episodes separate from PMVT/VF episodes and 5 had no history of SMVT. Triggering PVCs were identified in 11 patients and arose from an area of endocardial scar in 6. Only scar ablation was performed in 8 patients who did not have triggering PVCs. All idiopathic VF patients underwent PVC ablation only. During a median of 540 days, 74% of SHD patients and 77% of idiopathic VF patients were free of recurrence, including 75% of those with only PVC ablation, 86% of those with scar plus PVC ablation, and 63% of those with only scar ablation. CONCLUSION:Patients with recurrent PMVT/VF and SHD often have a low-voltage scar associated with PVCs or inducible SMVT, which may also be the substrate for PMVT/VF. When present, substrate ablation targeting scar is a reasonable option for treatment of PMVT/VF even if PVCs are absent.

journal_name

Heart Rhythm

journal_title

Heart rhythm

authors

Nakamura T,Schaeffer B,Tanigawa S,Muthalaly RG,John RM,Michaud GF,Tedrow UB,Stevenson WG

doi

10.1016/j.hrthm.2019.01.032

subject

Has Abstract

pub_date

2019-07-01 00:00:00

pages

1021-1027

issue

7

eissn

1547-5271

issn

1556-3871

pii

S1547-5271(19)30104-3

journal_volume

16

pub_type

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