Efficacy of radiofrequency catheter ablation for ventricular tachycardia in healed myocardial infarction

Callans, David J.; Zado, Erica S.; Sarter, Brian H.; Schwartzman, David; Gottlieb, Charles; Marchlinski, Francis E.

doi:10.1016/s0002-9149(98)00353-1

Cited by 70 publications

(43 citation statements)

References 14 publications

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“…It is clear that both the need for inducibility of the clinical arrhythmia 52 and the need for clinical tolerance to allow mapping limit the proportion of patients amenable to VT ablation if energy application has to be delivered during ongoing VT. 53 The introduction in clinical practice of a number of nonfluoroscopic navigation systems and the recognition of additional criteria to identify the substrate 54 -56 have allowed more precise identification of the VT substrate and consequently ablation of VT during sinus rhythm. Since the pioneer work of Marchlinski et al, 57 several other groups have used a variety of criteria to recognize and ablate the substrate, reporting good results and creating the expectation that an ablation approach also can be offered to post-MI VT patients in a more general fashion.…”

Section: Catheter Ablation Of the Vt Substratementioning

confidence: 99%

All Patients With Hemodynamically Tolerated Postinfarction Ventricular Tachycardia Do Not Require an Implantable Cardioverter-Defibrillator

Almendral

Josephson

2007

Circulation

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C onventional wisdom has long held that patients with tolerated ventricular tachycardia (VT) in the setting of chronic coronary heart disease are at low risk of arrhythmic death. This logic held that arrhythmia recurrence, although reasonably likely, could be predicted to be well tolerated. As with all truisms, it is good to reexamine this belief periodically. Disease states change; more information becomes available; and the general context of medical care improves. Expectations and capacity to tolerate risk, which are essentially societal rather than medical considerations, continue to evolve. Situations exist such as the present case in which this process of reexamination rather than the results of well-constructed randomized trials will determine the correct course. Response by Almendral and Josephson p 1203Many past studies have looked at this question at least tangentially. Despite this experience, no study directly answers this question in the present day. Our contemporary strategies for treating patients with advanced structural heart disease, including more aggressive revascularization and prevention of remodeling in heart failure, were not available during the time when these studies were performed. These strategies certainly have antiarrhythmic effects but more profoundly influence the natural history of progressive heart failure. There also have been marked changes in strategies for specific antiarrhythmic therapy. For all of these reasons, the data from trials performed in the 1980s and 1990s are reviewed for themes rather than direct answers.Despite these disclaimers, critical review of the evidence demonstrates that patients with structural heart disease (primarily healed myocardial infarction) who present with tolerated VT require implantable cardioverter-defibrillator (ICD) therapy. The foundations for this conclusion are as follows. First, tolerated VT is not a benign condition but signals a risk of life-threatening ventricular arrhythmias. Second, the benefit of secondary-prevention ICD therapy is difficult to challenge. Finally, successful catheter ablation does not sufficiently reduce residual risk. These considerations in the context of our current societal expectations for medical care make ICD therapy difficult if not impossible to avoid. Tolerated VT Signals a Risk of Life-Threatening ArrhythmiasThe logical bases for many ideas widely accepted in the "oral history" of electrophysiology are often difficult to determine. In my mind, the foundation of the idea that patients with tolerated VT will do well is formed by a series of early studies comparing patients who present with resuscitated cardiac arrest and tolerated VT. [1][2][3] These studies demonstrated that presentation with cardiac arrest was a major risk for sudden and total mortality; however, given the lack of appropriateThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association. CONTROVERSIES IN CARDIOVASCULAR MEDICINE 1196by guest on May 11, 2018 http://circ.ahajourn...

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Section: Catheter Ablation Of the Vt Substratementioning

confidence: 99%

All Patients With Hemodynamically Tolerated Postinfarction Ventricular Tachycardia Do Not Require an Implantable Cardioverter-Defibrillator

Almendral

Josephson

2007

Circulation

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“…The scar accompanying a myocardial infarction, for example, may limit both contributors to tissue ablation. 14,15 Driving conventional delivery systems to higher powers to enhance lesion size is limited by the occurrence of coagulum formation or the impedance rise, with a resulting decrease in power delivery to the myocardium 16 -18 and the potential for thromboembolic events.…”

Section: Limitations Of Standard Ablationmentioning

confidence: 99%

Discrepancies Between Catheter Tip and Tissue Temperature in Cooled-Tip Ablation

et al. 2005

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“…[1][2][3] An anatomically based approach deployed in sinus rhythm might eliminate the requirement for mapping all ventricular arrhythmias and extend the applicability of ablative therapy.…”

mentioning

confidence: 99%

Linear Ablation Lesions for Control of Unmappable Ventricular Tachycardia in Patients With Ischemic and Nonischemic Cardiomyopathy

et al. 2000

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Background-Conventional activation mapping is difficult without inducible, stable ventricular tachycardia (VT). Methods and Results-We evaluated 16 patients with drug refractory, unimorphic, unmappable VT. Nine patients had ischemic and 7 had nonischemic cardiomyopathy. All patients had implantable defibrillators and had experienced 6 to 55 VT episodes during the month before treatment. Patients underwent bipolar catheter mapping during baseline rhythm. The amount of endocardium with an abnormal electrogram amplitude was estimated using fluoroscopy in 3 patients and a magnetic mapping system (CARTO) in 13 patients. For the magnetic mapping, normal endocardium was defined by an amplitude Ͼ1.5 mV; this measurement was based on sinus rhythm maps in 6 patients who did not have structural heart disease. Radiofrequency point lesions extended linearly from the "dense scar," which had a voltage amplitude Ͻ0.5 mV, to anatomic boundaries or normal endocardium. To limit radiofrequency applications, 12-lead ECG during VT and pacemapping guided placement of linear lesions. No new antiarrhythmic drug therapy was added. The amount of endocardium demonstrating an abnormal electrogram amplitude ranged from 25 to 127 cm 2 . A total of 8 to 87 radiofrequency lesions (mean, 55) produced a median of 4 linear lesions that had an average length of 3.9 cm (range, 1.4 to 9.4 cm). Twelve patients (75%) have been free of VT during 3 to 36 months of follow-up (median, 8 months); 4 patients had VT episodes at 1, 3, 9, and 13 months, respectively. Only one of these patient had frequent VT. Conclusions-Radiofrequency linear endocardial lesions extending from the dense scar to the normal myocardium or anatomic boundary seem effective in controlling unmappable VT.

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Efficacy of radiofrequency catheter ablation for ventricular tachycardia in healed myocardial infarction

Cited by 70 publications

References 14 publications

All Patients With Hemodynamically Tolerated Postinfarction Ventricular Tachycardia Do Not Require an Implantable Cardioverter-Defibrillator

All Patients With Hemodynamically Tolerated Postinfarction Ventricular Tachycardia Do Not Require an Implantable Cardioverter-Defibrillator

Discrepancies Between Catheter Tip and Tissue Temperature in Cooled-Tip Ablation

Linear Ablation Lesions for Control of Unmappable Ventricular Tachycardia in Patients With Ischemic and Nonischemic Cardiomyopathy

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