Endo-Epicardial Homogenization of the Scar Versus Limited Substrate Ablation for the Treatment of Electrical Storms in Patients With Ischemic Cardiomyopathy

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:60

Article

Di Biase, Luigi^1,2,3  Santangeli, Pasquale^1,3  Burkhardt, David J.^1,4  Bai, Rong¹  Mohanty, Prasant¹  Carbucicchio, Corrado⁵  Dello Russo, Antonio⁵  Casella, Michela⁵  Mohanty, Sanghamitra¹  Pump, Agnes^1,6  Hongo, Richard⁴  Beheiry, Salwa⁴  Pelargonio, Gemma⁷  Santarelli, Pietro⁷  Zucchetti, Martina⁵  Horton, Rodney¹  Sanchez, Javier E.¹  Elayi, Claude S.⁸  Lakkireddy, Dhanunjay⁹  Tondo, Claudio⁵  Natale, Andrea^1,2,4 

[1] St Davids Med Ctr, Texas Cardiac Arrhythmia Inst, Austin, TX 78705 USA

[2] Univ Texas Austin, Dept Biomed Engn, Austin, TX 78712 USA

[3] Univ Foggia, Dept Cardiol, Foggia, Italy

[4] Calif Pacific Med Ctr, San Francisco, CA USA

[5] Ist Ricovero & Cura Carattere Sci, Cardiac Arrhythmia Res Ctr, Ctr Cardiol Monzino, Milan, Italy

[6] Univ Pecs, Inst Heart, Fac Med, Pecs, Hungary

[7] Univ Cattolica Sacro Cuore, Rome, Italy

[8] Univ Kentucky, Lexington, KY USA

[9] Univ Kansas, Kansas City, KS USA

关键词: catheter ablation;    electrical storm;    electrophysiology;    epicardial;    irrigated tip catheter;    ischemic cardiomyopathy;    mapping;    myocardial infarction;    scar;    ventricular tachycardia;   

DOI  :  10.1016/j.jacc.2012.03.044

来源: Elsevier

【 摘 要 】

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 +/- 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 +/- 5. During a mean follow-up of 25 +/- 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. (J Am Coll Cardiol 2012;60:132-41) (C) 2012 by the American College of Cardiology Foundation

【 授权许可】

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