Clinical, procedural and long-term outcome of ischemic VT ablation in patients with previous anterior versus inferior myocardial infarction

Abstract

Background Outcome of ischemic VT ablation may differ between patients with previous myocardial infarction (MI) in relation to infarct localization. Methods We analyzed procedural data, acute and long-term outcomes of 152 consecutive patients (139 men, mean age 67 ± 9 years) with previous anterior or inferior MI who underwent ischemic VT ablation at our institution between January 2010 and October 2015. Results More patients had a history of inferior MI (58%). Mean ejection fraction was significantly lower in anterior MI patients (28 ± 10% vs. 34 ± 10%, p < 0.001). NYHA class and presence of comorbidities were not different between the groups. Indication for the procedure was electrical storm in 43% of patients, and frequent implantable cardioverter defibrillator (ICD) therapies in 57%, and did not differ significantly between anterior and inferior MI patients. A mean of 3 ± 2 VT morphologies were inducible, with a trend towards more VT in the anterior MI group (3.1 ± 2.2 vs. 2.6 ± 1.9, p = 0.18). Procedural parameters and acute success did not differ between the groups. During a mean follow-up of 3 ± 2 years, more anterior MI patients had undergone a re-ablation (49% vs. 33%, p = 0.09, Chi-square test). There was a trend towards more ICD shocks in patients with previous anterior MI (46% vs. 34%). After adjusting for risk factors and ejection fraction, multivariable Cox regression analyses showed no significant difference in mortality (p = 0.78) and cardiovascular mortality between infarct localizations (p = 0.6). Conclusion Clinical characteristics of patients with anterior and inferior MI are similar except for ejection fraction. Patients with inferior MI appear to have better outcome regarding survival, ICD shocks and re-ablation, but this appears to be related to better ejection fraction when compared with anterior MI.

Panax quinquefolius L. Saponins Protect Myocardial Ischemia Reperfusion No-Reflow Through Inhibiting the Activation of NLRP3 Inflammasome via TLR4/MyD88/NF-κB Signaling Pathway

“…Previous research shows that reperfusion and NR are the main reasons for the deterioration of the cells exposed to the ischemic environment ( Wang et al, 2020b ). At the same time, it also leads to the poor prognosis of patients with acute myocardial infarction, such as cardiac arrhythmia, heart failure, and cardiogenic shock ( Vrints, 2020 ; Wasmer et al, 2020 ). The factors associated with the establishment of NR include endothelial dysfunction, compression of capillaries by swollen myocytes, leukocyte adherence, microvascular ischemia, oxidative stress, and inflammation ( Heusch, 2019 ; Wang et al, 2020b ).…”

Management of patients with an electrical storm or clustered ventricular arrhythmias: a clinical consensus statement of the European Heart Rhythm Association of the ESC—endorsed by the Asia-Pacific Heart Rhythm Society, Heart Rhythm Society, and Latin-American Heart Rhythm Society

“…In contrast, a recent observational study of 152 consecutive patients with cCAD (43% with ES) undergoing VT ablation found no differences in the incidence of ES between patients after anterior and inferior AMI. 34 In patients with NICM, the overall extent of the electroanatomical scar was similar, but lateral LV endocardial scar was more frequently observed in ES patients than in non-ES patients. 32 …”

The impact of ultra-high-density mapping on long-term outcome after catheter ablation of ventricular tachycardia

“…Besides optimal treatment of heart failure and concomitant conditions 2 , 3 , catheter ablation has become the gold standard to prevent recurring episodes 4 . Still, recurrences are sometimes seen, especially in patients with advanced stages of structural heart disease and heart failure 5 . Often a substrate-based ablation approach, targeting low-voltage areas and local abnormal ventricular activation (LAVA) is chosen, especially when mapping during active VT is hemodynamically not tolerated 6 .…”