Radiofrequency Catheter Ablation of Postinfarction Ventricular Tachycardia

Abstract

In patients with well-tolerated VT, RF catheter ablation may be useful as a primary cure if no other ventricular arrhythmias are inducible on follow-up testing. Ablation of all hemodynamically tolerated arrhythmias should be attempted in patients with multiple inducible VT morphologies because of the high rate of recurrence of unablated VTs in these patients.

Catheter Ablation of Ventricular Tachycardia - Long-Term Results

“…The acute ablation success rate is similar to the results of previous larger series of patients, who underwent catheter ablation of postinfarction sustained monomorphic VT 4,5,7 . In these series acute success of ablation procedure, which was around 70%, included both the patients, in whom none targeted VT morphology was inducible at the end of the study, as well as patients with modified, but still inducible VT.…”

“…As amiodarone may suppress other VT morphologies than that aimed with catheter ablation, it seems wise to continue the amiodarone therapy unless ICD is implanted 5 . Patients with modified or complex arrhythmogenic substrate, who have other rapid nonclinical VT morphologies inducible after successful elimination of clinical VT should probably receive ICD, which is supported by observation of almost 50% VT recurrences during the follow-up period in this subset of patients 4 . One patient with recent myocardial infarction deteriorated hemodynamically as a result of continuing ischemia not suitable for repeated revascularization and of incessant polymorphic VT with multiple discharges from ICD a day for the last three months.…”

“…Long-term follow-up in previous studies of postinfarction VT patients indicates around 60% arrhythmia free survival 4,5,7 in patients with successful ablation, while three quarters of patients, in whom ablation failed, experienced VT recurrence within four weeks of ablation 5 . The clinical outcome was even better (91% patients free of arrhythmia) in patients, who had not previous failed antiarrhythmic drug therapy.…”

“…Simultaneous complex cardiological management with cardiac revascularization, beta-blocker, ACE inhibitors and hypolipidemic therapy is inherent part of the patients management. The impact of catheter ablation of ventricular tachycardia(s) (VT) on survival in patients with structural heart disease is unknown and therefore only rarely the catheter ablation alone can be considered a method for cure 2,3,4,5 . It is usually reserved for frequent symptomatic drug resistant episodes of the arrhythmia in patients with ICD already implanted 6,7 .…”

Tachycardia-Related Channel in the Scar Tissue in Patients With Sustained Monomorphic Ventricular Tachycardias

“…These areas are identified by the recording of presystolic electrograms during tachycardia. [1][2][3][4][5][6] Human studies have demonstrated that these slow-conduction areas take place in narrow bundles of viable tissue that function as conducting channels (CCs) bounded by scarred tissue. 7,8 Those CCs that are located in the endocardium are identified during tachycardia.…”