AIMS: The prognostic significance of multiple ventricular tachycardia (VT) morphologies, whether spontaneous or induced, was investigated in patients who underwent radiofrequency catheter ablation (RFCA) for postinfarction ventricular tachycardia. METHODS AND RESULTS: We studied 137 patients with postinfarction ventricular tachycardia. Catheter ablation of all induced ventricular tachycardias was attempted. A single ventricular tachycardia morphology was documented in 102/137 patients (MONO group); 35 patients had spontaneous pleomorphism (PLEO group). Multiple VT morphologies were induced in 58/102 (57%) MONO patients and in all PLEO patients. A higher rate of arrhythmia suppression was obtained in MONO as compared to PLEO patients (162/212 [76%] vs. 43/110 [39%]). Clinical presentation (VT pleomorphism) (OR: 0.22, CI: 0.08-0.62) and the induced VT cycle (mean PLEO/MONO: 338/385 ms, OR: 1.06) were independent predictors of acute RFCA success. Among MONO patients, the procedure was successful in 75% of the patients with a single induced ventricular tachycardia compared to 64% of those with multiple tachycardias. The acute success rate was lower in PLEO patients (23%). PLEO patients had a significantly higher 3- and 5-year arrhythmia recurrence rate than MONO patients. RFCA acute success was the only independent predictor of long-term outcome in multivariate analysis. CONCLUSIONS: Spontaneous, but not induced, VT pleomorphism in patients with prior myocardial infarction adversely affects the acute and long-term success rate of RFCA.
AIMS: The prognostic significance of multiple ventricular tachycardia (VT) morphologies, whether spontaneous or induced, was investigated in patients who underwent radiofrequency catheter ablation (RFCA) for postinfarction ventricular tachycardia. METHODS AND RESULTS: We studied 137 patients with postinfarction ventricular tachycardia. Catheter ablation of all induced ventricular tachycardias was attempted. A single ventricular tachycardia morphology was documented in 102/137 patients (MONO group); 35 patients had spontaneous pleomorphism (PLEO group). Multiple VT morphologies were induced in 58/102 (57%) MONO patients and in all PLEO patients. A higher rate of arrhythmia suppression was obtained in MONO as compared to PLEO patients (162/212 [76%] vs. 43/110 [39%]). Clinical presentation (VT pleomorphism) (OR: 0.22, CI: 0.08-0.62) and the induced VT cycle (mean PLEO/MONO: 338/385 ms, OR: 1.06) were independent predictors of acute RFCA success. Among MONO patients, the procedure was successful in 75% of the patients with a single induced ventricular tachycardia compared to 64% of those with multiple tachycardias. The acute success rate was lower in PLEO patients (23%). PLEO patients had a significantly higher 3- and 5-year arrhythmia recurrence rate than MONO patients. RFCA acute success was the only independent predictor of long-term outcome in multivariate analysis. CONCLUSIONS: Spontaneous, but not induced, VT pleomorphism in patients with prior myocardial infarction adversely affects the acute and long-term success rate of RFCA.
Authors: Roderick Tung; Marmar Vaseghi; David S Frankel; Pasquale Vergara; Luigi Di Biase; Koichi Nagashima; Ricky Yu; Sitaram Vangala; Chi-Hong Tseng; Eue-Keun Choi; Shaan Khurshid; Mehul Patel; Nilesh Mathuria; Shiro Nakahara; Wendy S Tzou; William H Sauer; Kairav Vakil; Usha Tedrow; J David Burkhardt; Venkatakrishna N Tholakanahalli; Anastasios Saliaris; Timm Dickfeld; J Peter Weiss; T Jared Bunch; Madhu Reddy; Arun Kanmanthareddy; David J Callans; Dhanunjaya Lakkireddy; Andrea Natale; Francis Marchlinski; William G Stevenson; Paolo Della Bella; Kalyanam Shivkumar Journal: Heart Rhythm Date: 2015-05-30 Impact factor: 6.343
Authors: Roland Richard Tilz; Tina Lin; Lars Eckardt; Thomas Deneke; Dietrich Andresen; Heinrich Wieneke; Johannes Brachmann; Stefan Kääb; K R Julian Chun; Paula Münkler; Thorsten Lewalter; Matthias Hochadel; Jochen Senges; Karl-Heinz Kuck Journal: J Am Heart Assoc Date: 2018-03-23 Impact factor: 5.501
Authors: Michifumi Tokuda; Pipin Kojodjojo; Stanley Tung; Usha B Tedrow; Eyal Nof; Keiichi Inada; Bruce A Koplan; Gregory F Michaud; Roy M John; Laurence M Epstein; William G Stevenson Journal: J Am Heart Assoc Date: 2013-05-31 Impact factor: 5.501