Document Detail

Radiofrequency catheter ablation of postinfarction ventricular tachycardia: long-term success and the significance of inducible nonclinical arrhythmias.
MedLine Citation:
PMID:  9396447     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Radiofrequency (RF) catheter ablation is effective therapy for monomorphic ventricular tachycardia (VT) in patients without structural heart disease. In patients with postinfarction VT; however, this procedure has been used predominantly as adjunctive therapy, targeting only the patient's clinically documented arrhythmia. By targeting all inducible, sustained VT morphologies, we sought to determine the utility of RF catheter ablation as a primary cure in patients who present with hemodynamically tolerated VT. METHODS AND RESULTS: RF ablation was attempted in 35 patients with a previous myocardial infarction and recurrent, hemodynamically tolerated VT. A mean of 3.9+/-2.7 VTs were induced per patient (range, 1 to 10). The clinically documented arrhythmia was successfully ablated in 30 of 35 patients (86%), and on follow-up electrophysiological testing, 11 patients had no inducible VT and were discharged without other therapy. Nineteen patients had inducible "nonclinical" arrhythmias on follow-up testing, and the majority underwent cardiac defibrillator implantation. Freedom from recurrent arrhythmias, including sudden death, was 91% in patients without inducible VT and 53% in patients with persistently inducible "nonclinical" arrhythmias (P<.05; mean follow-up, 17+/-12 and 12+/-11 months, respectively). CONCLUSIONS: In patients with well-tolerated VT, RF catheter ablation may be useful as a primary cure if no other ventricular arrhythmias are inducible on follow-up testing. Ablation of all hemodynamically tolerated arrhythmias should be attempted in patients with multiple inducible VT morphologies because of the high rate of recurrence of unablated VTs in these patients.
S A Rothman; H H Hsia; S F Cossú; I L Chmielewski; A E Buxton; J M Miller
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  96     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1997 Nov 
Date Detail:
Created Date:  1998-01-09     Completed Date:  1998-01-09     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  3499-508     Citation Subset:  AIM; IM    
Temple University School of Medicine, Philadelphia, Pa, USA.
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MeSH Terms
Arrhythmias, Cardiac / physiopathology
Catheter Ablation* / adverse effects
Middle Aged
Myocardial Infarction / complications*
Tachycardia, Ventricular / etiology*,  surgery*
Time Factors
Treatment Failure
Treatment Outcome

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