Document Detail


Ventricular tachycardia ablation: evolution of patients and procedures over 8 years.
MedLine Citation:
PMID:  19808409     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Evolving management of coronary artery disease, heart failure, and the use of implantable cardioverter-defibrillators impacts the characteristics of patients with recurrent ventricular tachycardia (VT). We investigated the substrate, procedure, and outcome evolution of all patients referred for VT ablation during the past 8 years. METHODS AND RESULTS: From 1999 to 2006, 493 consecutive patients (358 male, 57+/-16 years) underwent 623 VT ablations: 131 had no structural heart disease (SHD), 213 had ischemic cardiomyopathies (ICMP), and 149 had nonischemic cardiomyopathies (NICMP). Although the main substrate is ICMP, the proportion of NICMP has increased from 27% to 35% (P=0.06) from 1999-2002 to the 2003-2006. The procedure abolished or modified inducible VTs in > or =75% of patients in all groups, but abolition of all monomorphic VTs was achieved in 125 (83%) patients without SHD, 180 (65%) with ICMP, and 99 (51%) with NICMP (P<0.0001). During a mean follow-up of 3.3+/-2.4 years, no deaths occurred in patients without SHD, but 75 patients (35%) with ICMP and 26 patients (17%) with NICMP died after a median of 13 months. Multivariate Cox regression analysis found that age, ejection fraction, and need for preprocedural mechanical hemodynamic support predicted mortality. CONCLUSIONS: The substrate causing VT in patients requiring ablation is evolving and determines the long-term outcome. In the setting of a normal heart, VT ablation is associated with a low risk of subsequent mortality, with no deaths occurring during a mean follow-up of >3 years. In contrast, in patients with SHD and recurrent VT, VT ablation can be helpful to suppress drug refractory VT, but long-term mortality remains significant.
Authors:
Frédéric Sacher; Usha B Tedrow; Michael E Field; Jean-Marc Raymond; Bruce A Koplan; Laurence M Epstein; William G Stevenson
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-06-06
Journal Detail:
Title:  Circulation. Arrhythmia and electrophysiology     Volume:  1     ISSN:  1941-3084     ISO Abbreviation:  Circ Arrhythm Electrophysiol     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2009-10-07     Completed Date:  2009-10-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101474365     Medline TA:  Circ Arrhythm Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  153-61     Citation Subset:  IM    
Affiliation:
Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiomyopathies / complications*,  mortality
Catheter Ablation / methods*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Ischemia / complications*,  mortality
Prognosis
Retrospective Studies
Risk Factors
Survival Rate / trends
Tachycardia, Ventricular / etiology,  mortality,  surgery*
Time Factors
United States / epidemiology
Comments/Corrections
Comment In:
Circ Arrhythm Electrophysiol. 2008 Aug;1(3):147-9   [PMID:  19808407 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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