Long-Term Success of Irrigated Radiofrequency Catheter Ablation of Sustained Ventricular Tachycardia

Marchlinski, Francis E.; Haffajee, Charles I.; Beshai, John F.; Dickfeld, Timm; González, Mario D.; Hsia, Henry H.; Schuger, Claudio; Beckman, Karen J.; Bogun, Frank; Pollak, Scott J.; Bhandari, Anil K.

doi:10.1016/j.jacc.2015.11.041

Cited by 137 publications

(59 citation statements)

References 21 publications

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“…13-22 Patients with recurrence of ventricular tachycardia despite catheter ablation have a poor prognosis associated with progressive heart failure and irrepressible ventricular tachycardia, with a risk of death that is four to six times the risk among patients who do not have such a recurrence. 13,15,17,25 …”

Section: Discussionmentioning

confidence: 99%

Noninvasive Cardiac Radiation for Ablation of Ventricular Tachycardia

Schill²,

et al. 2017

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BACKGROUND Recent advances have enabled noninvasive mapping of cardiac arrhythmias with electrocardiographic imaging and noninvasive delivery of precise ablative radiation with stereotactic body radiation therapy (SBRT). We combined these techniques to perform catheter-free, electrophysiology-guided, noninvasive cardiac radioablation for ventricular tachycardia. METHODS We targeted arrhythmogenic scar regions by combining anatomical imaging with noninvasive electrocardiographic imaging during ventricular tachycardia that was induced by means of an implantable cardioverter–defibrillator (ICD). SBRT simulation, planning, and treatments were performed with the use of standard techniques. Patients were treated with a single fraction of 25 Gy while awake. Efficacy was assessed by counting episodes of ventricular tachycardia, as recorded by ICDs. Safety was assessed by means of serial cardiac and thoracic imaging. RESULTS From April through November 2015, five patients with high-risk, refractory ventricular tachycardia underwent treatment. The mean noninvasive ablation time was 14 minutes (range, 11 to 18). During the 3 months before treatment, the patients had a combined history of 6577 episodes of ventricular tachycardia. During a 6-week postablation “blanking period” (when arrhythmias may occur owing to postablation inflammation), there were 680 episodes of ventricular tachycardia. After the 6-week blanking period, there were 4 episodes of ventricular tachycardia over the next 46 patient-months, for a reduction from baseline of 99.9%. A reduction in episodes of ventricular tachycardia occurred in all five patients. The mean left ventricular ejection fraction did not decrease with treatment. At 3 months, adjacent lung showed opacities consistent with mild inflammatory changes, which had resolved by 1 year. CONCLUSIONS In five patients with refractory ventricular tachycardia, noninvasive treatment with electrophysiology-guided cardiac radioablation markedly reduced the burden of ventricular tachycardia. (Funded by Barnes–Jewish Hospital Foundation and others.)

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Section: Discussionmentioning

confidence: 99%

Noninvasive Cardiac Radiation for Ablation of Ventricular Tachycardia

Schill²,

et al. 2017

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“…RFCA is a safe and effective treatment option for scar-mediated VT. [6,22,27–30] In the randomized Substrate Mapping and Ablation in Sinus Rhythm to Halt Ventricular Tachycardia (SMASH-VT) trial, catheter ablation reduced ICD therapies by 65% during 2-year follow-up in post-MI patients receiving ICDs for secondary prevention. [28] The Ventricular Tachycardia Ablation in Coronary Heart Disease (VTACH) study randomized 107 post-MI patients with stable VT to ICD implantation and VT ablation or ICD implantation alone.…”

Section: Discussionmentioning

confidence: 99%

“…Entrainment mapping and pace mapping were also performed. If the VTs were hemodynamically unstable or not inducible but recorded by 12-lead ECG before the EPS procedure, ablation was guided on the basis of detailed characterization of the substrate defined by voltage mapping in sinus rhythm, including identification of split or late potentials, discrete higher voltage channels in the low-voltage region, and/or pace mapping in which the QRS with pacing mimics induced and/or spontaneous VT. [22] During left ventricular endocardial mapping, heparin was given to maintain a target activated clotting time of 200 to 250 seconds.…”

Section: Methodsmentioning

confidence: 99%

Aneurysm-related ischemic ventricular tachycardia

Guo

Zheng²,

Wu³

et al. 2017

Medicine

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Left ventricular aneurysm (LVA) postmyocardial infarction (MI) might be an arrhythmogenic substrate. We examined the safety and efficacy of catheter ablation of LVA-related ventricular tachycardia (VT).Thirty-three consecutive patients who underwent primary catheter ablation of ischemic VT were divided into LVA group (11 patients, mean age 61.9 years, 10 men) and none LVA group. Acute procedural outcomes, complications, and long-term outcomes were assessed.In LVA group, average number of induced VTs were 3.2 ± 2.6 (range 1–7), clinical VTs were located in the ventricular septum scar zone in 4 (36.4%) patients, acute success was achieved in 7 (63.6%) patients, partial success in 3 (27.3%) and failure in 1 patient, while none LVA group showing a statistically similar distribution of acute procedural outcomes (P = 0.52). There were no major or life-threatening complications. VT-free survival rate at median 19 (1–44) months follow-up was numerically but not significantly lower in LVA versus none LVA group (48.5% vs 62.8%, log-rank P = 0.40).Catheter ablation of ischemic VT in the presence of LVA appears feasible and effective, with about one-third of cases having septal ablation targets. Further studies are warranted.

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“…Data from the THERMOCOOL VT trial looking at the long-term success of open irrigated radiofrequency (RF) catheter ablation of monomorphic VT associated with coronary artery disease showed reduced ICD shocks and VT episodes with improved quality of life at 6 months. At 3-year follow-up, non-recurrence resulted in decreased amiodarone use and hospitalizations 67 .…”

Section: Invasive Mapping and Catheter Ablation Of Ventricular Tachycmentioning

confidence: 98%

Recent advances in the management of ventricular tachyarrhythmias

et al. 2017

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Ventricular arrhythmias are an important cause of cardiovascular morbidity and mortality, particularly in those with structural heart disease, inherited cardiomyopathies, and channelopathies. The goals of ventricular arrhythmia management include symptom relief, improving quality of life, reducing implantable cardioverter defibrillator shocks, preventing deterioration of left ventricular function, reducing risk of arrhythmic death, and potentially improving overall survival. Guideline-directed medical therapy and implantable cardioverter defibrillator implantation remain the mainstay of therapy to prevent sudden cardiac death in patients with ventricular arrhythmias in the setting of structural heart disease. Recent advances in imaging modalities and commercial availability of genetic testing panels have enhanced our mechanistic understanding of the disease processes and, along with significant progress in catheter-based ablative therapies, have enabled a tailored and more effective management of drug-refractory ventricular arrhythmias. Several gaps in our knowledge remain and require further research. In this article, we review the recent advances in the diagnosis and management of ventricular arrhythmias.

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Long-Term Success of Irrigated Radiofrequency Catheter Ablation of Sustained Ventricular Tachycardia

Cited by 137 publications

References 21 publications

Noninvasive Cardiac Radiation for Ablation of Ventricular Tachycardia

Noninvasive Cardiac Radiation for Ablation of Ventricular Tachycardia

Aneurysm-related ischemic ventricular tachycardia

Recent advances in the management of ventricular tachyarrhythmias

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