Noninvasive Programmed Ventricular Stimulation Early After Ventricular Tachycardia Ablation to Predict Risk of Late Recurrence

Frankel, David S.; Mountantonakis, Stavros; Zado, Erica S.; Anter, Elad; Bala, Rupa; Cooper, Joshua M.; Deo, Rajat; Dixit, Sanjay; Epstein, Andrew E.; García, Fermin C.; Gerstenfeld, Edward P.; Hutchinson, Mathew D.; Lin, David; Patel, Vickas V.; Riley, Michael P.; Robinson, Melissa; Tzou, Wendy S.; Verdino, Ralph J.; Callans, David J.; Marchlinski, Francis E.

doi:10.1016/j.jacc.2012.01.026

Cited by 98 publications

(69 citation statements)

References 18 publications

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“…PVS is a widely accepted tool to test for acute procedural success after CA of VT. [16][17][18] Previous studies have shown that VT noninducibility after CA was associated with improved VTfree survival and reduced mortality in patients with coronary artery disease. 2,5,18 In contrast, the influence of postprocedural VT inducibility as a proof of acute success on the outcomes in patients with NIDCM is controversial and based on data from several studies with a limited number of patients.…”

Section: Discussionmentioning

confidence: 99%

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Catheter Ablation of Ventricular Tachycardia and Mortality in Patients With Nonischemic Dilated Cardiomyopathy

Dinov

Arya

Schratter

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Background-Data on outcomes after catheter ablation of ventricular tachycardia (VT) in patients with nonischemic dilated cardiomyopathy (NIDCM) are insufficient. We aimed to investigate the effects of successful catheter ablation of VT on cardiac mortality in patients with NIDCM. Methods and Results-One hundred two patients with NIDCM (86 men; mean age, 58.8±15.2 years; mean ejection fraction, 33.3±11.9%) underwent VT ablation. After catheter ablation, a programmed ventricular stimulation to test for success was performed. Complete VT noninducibility was achieved in 62 (61%) patients and partial success or failure in 32 (31%) patients. During 2 years of follow-up, VT recurrence was observed in 33 patients (53%) without inducible VTs and in 24 patients (75%) with inducible VT inducible (P=0.041). VT inducibility was associated with higher VT recurrence (adjusted hazard ratio, 1.84; 95% confidence interval, 1.08-3.13; P=0.025). The primary end point of all-cause mortality was reached in 9 patients (15%) with noninducible VTs versus 11 patients (34%) with inducible sustained VTs (P=0.026). VT inducibility was associated with all-cause mortality (adjusted hazard ratio, 2.73; 95% confidence interval, 1.003-7.43; P=0.049). Conclusions-In patients with NIDCM and recurrent sustained VTs, a complete ablation of all inducible VTs may be achieved in 60% of the cases. The complete noninducibility may be a preferable end point of ablation because it was associated with better long-term success. Importantly, if possible to achieve through ablation, a complete VT noninducibility was associated with reduction of the likelihood for all-cause mortality in patients with NIDCM.

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Section: Discussionmentioning

confidence: 99%

“…2,5,18 In contrast, the influence of postprocedural VT inducibility as a proof of acute success on the outcomes in patients with NIDCM is controversial and based on data from several studies with a limited number of patients.…”

Section: Discussionmentioning

confidence: 99%

Catheter Ablation of Ventricular Tachycardia and Mortality in Patients With Nonischemic Dilated Cardiomyopathy

Dinov

Arya

Schratter

et al. 2015

Circ: Arrhythmia and Electrophysiology

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“…Non-invasive programmed stimulation through the ICD is performed 1-2 d after the ablation off antiarrhythmic drugs (AADs) to ensure continued non-inducibility [34] . Induction of VT suggests the need for further ablation in order to achieve a favorable long-term antiarrhythmic drug-free outcome.…”

Section: Procedural Endpointsmentioning

confidence: 99%

Ventricular tachycardia mapping and ablation in arrhythmogenic right ventricular cardiomyopathy/dysplasia: Lessons Learned

Tschabrunn

Marchlinski

2014

WJC

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Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is primarily believed to be an inherited cardiomyopathy that subsequently results in significant myocardial fibrosis. The arrhythmogenic consequences that result from the development of fibrosis are similar to other nonischemic cardiomyopathies, but the unique endocardial-epicardial disease process of ARVC/D requires a specialized approach for arrhythmia treatment in the electrophysiology laboratory. Although the association between ARVC/D and development of ventricular arrhythmias has become increasingly clear over the last 2 decades, our understanding of the arrhythmia mechanisms, underlying electrophysiologic substrate, and treatment strategies were significantly limited. Prospective studies performed in the electrophysiology laboratory allowed detailed characterization of the electrophysiologic and electroanatomic substrate underlying ventricular tachycardia in patients with ARVC/D. This has allowed clinician scientists to better characterize the arrhythmia mechanism and develop the necessary strategies to perform successful catheter ablation. Early in this experience, catheter ablation was considered a limited and largely unsuccessful treatment for patients experiencing painful and recurrent defibrillator therapy. Through our increased understanding of the disease process, catheter ablation has evolved to become an effective and preferred therapy for a majority of these patients. Our understanding of the disease and necessary approaches to provide successful treatment continues to evolve as the clinical experience grows. This article will review these important insights from the electrophysiology laboratory and how application of this knowledge has facilitated the development of a methodical approach to successfully perform ventricular tachycardia ablation in patients with ARVC/D.

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“…52 All patients included had been rendered non-inducible for VT at the index ablation procedure. Of 132 patients, 24 (18 %) were inducible for the clinical VT and experienced significantly higher VT recurrence including VT storm.…”

Section: Scar-related Ventricular Tachycardiamentioning

confidence: 99%

Catheter Ablation for Ventricular Arrhythmias

Nof

Stevenson

John

2013

Arrhythmia &Amp; Electrophysiology Review

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Sustained ventricular tachycardia (VT) and ventricular fibrillation (VF)are typically a manifestation of significant structural heart disease and often associated with a high risk of sudden cardiac death. Implantable cardioverter defibrillators (ICDs) remain the mainstay of therapy for prevention of sudden cardiac death associated with these arrhythmias. 1 However, ICDs treat the arrhythmia after it occurs and does not prevent the arrhythmia. Recurrent ventricular arrhythmias can lead to multiple ICD shocks that are painful, decrease quality of life and cause post-traumatic stress disorder. Spontaneous VT and ICD shocks are also associated with an increased risk of death and progressive heart failure.2 Antiarrhythmic drugs, notably amiodarone, reduce arrhythmias for some patients, but have limited efficacy for long-term management, particularly for scar-related re-entrant arrhythmias. 3In addition, antiarrhythmic drugs have the potential for significant adverse effects that includes negative inotropy, pro-arrhythmia and non-cardiac organ toxicities that limit their long-term use.3,4 Catheter ablation offers an alternative therapy for preventing arrhythmias, and can be life-saving when frequent episodes (VT storm) threaten survival.VT or repetitive premature ventricular contractions (PVCs) may also occur in the absence of structural heart disease.5 These arrhythmias are often termed 'idiopathic' and generally carry a benign prognosis, but symptoms warrant therapy in some patients. In addition, frequent ventricular arrhythmia can lead to ventricular dysfunction. 6 The cause of depressed ventricular function is often unclear at the initial presentation and the diagnosis of arrhythmia induced ventricular dysfunction may become apparent only after effective suppression of PVCs or VT. Mapping and Ablation Technologies and Procedural ConsiderationsRadiofrequency (RF) current remains the most commonly used energy source. Lesion size is limited by coagulum formation on the electrode when electrode temperature exceeds 70 degrees Celsius. AbstractCatheter ablation has emerged as an important and effective treatment option for many recurrent ventricular arrhythmias. The approach to ablation and the risks and outcomes are largely determined by the nature of the severity and type of underlying heart disease. In patients with structural heart disease, catheter ablation can effectively reduce ventricular tachycardia (VT) episodes and implantable cardioverter defibrillator (ICD) shocks. For VT and symptomatic premature ventricular beats that occur in the absence of structural heart disease, catheter ablation is often effective as the sole therapy. Advances in catheter technology, imaging and mapping techniques have improved success rates for ablation. This review discusses current approaches to mapping and ablation for ventricular arrhythmias.

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Noninvasive Programmed Ventricular Stimulation Early After Ventricular Tachycardia Ablation to Predict Risk of Late Recurrence

Cited by 98 publications

References 18 publications

Catheter Ablation of Ventricular Tachycardia and Mortality in Patients With Nonischemic Dilated Cardiomyopathy

Catheter Ablation of Ventricular Tachycardia and Mortality in Patients With Nonischemic Dilated Cardiomyopathy

Ventricular tachycardia mapping and ablation in arrhythmogenic right ventricular cardiomyopathy/dysplasia: Lessons Learned

Catheter Ablation for Ventricular Arrhythmias

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