Objectives: This study investigated the impact on recurrences of 2 different substrate approaches for the treatment of these arrhythmias. Background: Catheter ablation of electrical storms (ES) for ventricular arrhythmias (VAs) has shown moderate long-term efficacy in patients with ischemic cardiomyopathy. Methods: Ninety-two consecutive patients (81% male, age 62 Â± 13 years) with ischemic cardiomyopathy and ES underwent catheter ablation. Patients were treated either by confining the radiofrequency lesions to the endocardial surface with limited substrate ablation (Group 1, n = 49) or underwent endocardial and epicardial ablation of abnormal potentials within the scar (homogenization of the scar, Group 2, n = 43). Epicardial access was obtained in all Group 2 patients, whereas epicardial ablation was performed in 33% (14) of these patients. Results: Mean ejection fraction was 27 Â± 5. During a mean follow-up of 25 Â± 10 months, the VAs recurrence rate of any ventricular tachycardia (VTs) was 47% (23 of 49 patients) in Group 1 and 19% (8 of 43 patients) in Group 2 (log-rank p = 0.006). One patient in Group 1 and 1 patient in Group 2 died at follow-up for noncardiac reasons. Conclusions: Our study demonstrates that ablation using endo-epicardial homogenization of the scar significantly increases freedom from VAs in ischemic cardiomyopathy patients.
Endo-epicardial homogenization of the scar versus limited substrate ablation for the treatment of electrical storms in patients with ischemic cardiomyopathy / L. Di Biase, P. Santangeli, D.J. Burkhardt, R. Bai, P. Mohanty, C. Carbucicchio, A. Dello Russo, M. Casella, S. Mohanty, A. Pump, R. Hongo, S. Beheiry, G. Pelargonio, P. Santarelli, M. Zucchetti, R. Horton, J.E. Sanchez, C.S. Elayi, D. Lakkireddy, C. Tondo, A. Natale. - In: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. - ISSN 0735-1097. - 60:2(2012), pp. 132-141.
|Titolo:||Endo-epicardial homogenization of the scar versus limited substrate ablation for the treatment of electrical storms in patients with ischemic cardiomyopathy|
|Parole Chiave:||catheter ablation; electrical storm; electrophysiology; epicardial; irrigated tip catheter; ischemic cardiomyopathy; mapping; myocardial infarction; scar; ventricular tachycardia; Aged; Catheter Ablation; Cicatrix; Defibrillators, Implantable; Electrocardiography; Endocardium; Female; Humans; Male; Middle Aged; Multivariate Analysis; Myocardial Ischemia; Pericardium; Prospective Studies; Recurrence; Tachycardia, Ventricular; Electrophysiologic Techniques, Cardiac; Epicardial Mapping; Cardiology and Cardiovascular Medicine|
|Settore Scientifico Disciplinare:||Settore MED/11 - Malattie dell'Apparato Cardiovascolare|
|Data di pubblicazione:||2012|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1016/j.jacc.2012.03.044|
|Appare nelle tipologie:||01 - Articolo su periodico|