Aneurysm-related ischemic ventricular tachycardia

Abstract

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.

Epicardial Ablation as a Treatment of Recurrent Ventricular Tachycardia Originating From a Left Ventricular Aneurysm: A Case Report and Review of the Literature

“…However, substrates for VT are not limited to the subendocardial myocardium. Moreover, an LVA can become an arrhythmogenic substrate for LVA-related VT, which is usually located in the aneurysm border zone [ 11 ]. However, the characteristically thin and hyaline fibrous tissue of LVA’s apical aneurysmal wall makes the ablation of VT in patients with ischemic cardiomyopathy quite challenging [ 11 ].…”

“…Moreover, an LVA can become an arrhythmogenic substrate for LVA-related VT, which is usually located in the aneurysm border zone [ 11 ]. However, the characteristically thin and hyaline fibrous tissue of LVA’s apical aneurysmal wall makes the ablation of VT in patients with ischemic cardiomyopathy quite challenging [ 11 ]. The percutaneous epicardial approach for mapping and the accompanying ablation has been appropriately used for the treatment of such subepicardial VT [ 12 ].…”

“…The use of epicardial ablation as a preemptive and adjunctive strategy has been reported in multiple observational studies [14][15][16]. Although the data on the safety and efficacy of CA for VT in patients with LVA is limited, the available studies indicate that ablation of VT in the presence of LVA can achieve relatively high efficacy and acceptable complication rates in high-risk patients [11,16].…”

Catheter ablation of ventricular tachycardia in patients with postinfarction left ventricular aneurysm

“…Post-infarction LVA represents a challenging condition during VT ablation. 5,8 The majority of our patients had a large remodeled LV as manifest by the low baseline EF and large LV and LVA dimension.…”

“…6 However, while VT in the setting of post-MI LVA is not uncommonly encountered, there is a scarcity of data in the published literature regarding the safety, efficacy, and outcomes of RFA of VT in this subset of patients. 7,8 2 | METHODS…”