Yuki Komatsu1, Mélèze Hocini2,3,4, Akihiko Nogami1, Philippe Maury5, Petr Peichl6, Yu-Ki Iwasaki7, Keita Masuda8, Arnaud Denis2,3,4, Quentin Voglimacci-Stephanopoli5, Dan Wichterle6, Mitsuharu Kawamura9, Seiji Fukamizu10, Yasuhiro Yokoyama11, Yasushi Mukai12, Tomoo Harada13, Kentaro Yoshida14, Ryobun Yasuoka15, Masayuki Igawa16, Koji Ohira17, Wataru Shimizu7, Kazutaka Aonuma1, Josef Kautzner6, Michel Haïssaguerre2,3,4, Masaki Ieda1. 1. Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan (Y.K., A.N., K.A., M.I.). 2. Bordeaux University Hospital (Centre Hospitalier Universitaire [CHU]), Electrophysiology and Ablation Unit, Pessac, France (M.H., A.D., M.H.). 3. Institut Hospitalo-Universitaire (IHU) Liryc, Electrophysiology and Heart Modeling Institute, Pessac-Bordeaux, France (M.H., A.D., M.H.). 4. University Bordeaux, Centre de Recherche Cardio-thoracique de Bordeaux, France (M.H., A.D., M.H.). 5. Hospital Rangueil, Centre Hospitalier Universitaire Toulouse, France (P.M., Q.V.-S.). 6. Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., D.W., J.K.). 7. Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (Y.-k.I., W.S.). 8. Department of Heart Rhythm Management, Yokohama Rosai Hospital, Japan (K.M.). 9. Division of Cardiology, Showa University School of Medicine, Tokyo, Japan (M.K.). 10. Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Japan (S.F.). 11. Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan (Y.Y.). 12. Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan (Y.M.). 13. Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan (T.H.). 14. Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Japan (K.Y.). 15. Department of Medicine, Faculty of Medicine, Division of Cardiovascular Center, Kinki University School of Medicine, Osaka, Japan (R.Y.). 16. Division of Cardiology, Tsukuba Memorial Hospital, Japan (M.I.). 17. Department of Cardiology, Mito Saiseikai General Hospital, Japan (K.O.).
Abstract
BACKGROUND: Ventricular fibrillation (VF) storm after myocardial infarction (MI) is a life-threatening condition that necessitates multiple defibrillations. Catheter ablation is a potentially effective treatment strategy for VF storm refractory to optimal medical treatment. However, its impact on patient survival has not been verified in a large population. METHODS: We conducted a multicenter, retrospective observational study involving consecutive patients who underwent catheter ablation of post-MI refractory VF storm without preceding monomorphic ventricular tachycardia. The target of ablation was the Purkinje-related ventricular extrasystoles triggering VF. The primary outcome was in-hospital and long-term mortalities. Univariate logistic regression and Cox proportional-hazards analysis were used to evaluate clinical characteristics associated with in-hospital and long-term mortalities, respectively. RESULTS: One hundred ten patients were enrolled (age, 65±11years; 92 men; left ventricular ejection fraction, 31±10%). VF storm occurred at the acute phase of MI (4.5±2.5 days after the onset of MI during the index hospitalization for MI) in 43 patients (39%), the subacute phase (>1 week) in 48 (44%), and the remote phase (>6 months) in 19 (17%). The focal triggers were found to originate from the scar border zone in 88 patients (80%). During in-hospital stay after ablation, VF storm subsided in 92 patients (84%). Overall, 30 (27%) in-hospital deaths occurred. The duration from the VF occurrence to the ablation procedure was associated with in-hospital mortality (odds ratio for each 1-day increase, 1.11 [95% CI, 1.03-1.20]; P=0.008). During follow-up after discharge from hospital, only 1 patient developed recurrent VF storm. However, 29 patients (36%) died, with a median survival time of 2.2 years (interquartile range, 1.2-5.5 years). Long-term mortality was associated with left ventricular ejection fraction <30% (hazard ratio, 2.54 [95% CI, 1.21-5.32]; P=0.014), New York Heart Association class ≥III (hazard ratio, 2.68 [95% CI, 1.16-6.19]; P=0.021), a history of atrial fibrillation (hazard ratio, 3.89 [95% CI, 1.42-10.67]; P=0.008), and chronic kidney disease (hazard ratio, 2.74 [95% CI, 1.15-6.49]; P=0.023). CONCLUSIONS: In patients with MI presenting with focally triggered VF storm, catheter ablation of culprit triggers is lifesaving and appears to be associated with short- and long-term freedom from recurrent VF storm. Mortality over the long-term follow-up is associated with the severity of underlying cardiovascular disease and comorbidities in this specific patient population.
BACKGROUND:Ventricular fibrillation (VF) storm after myocardial infarction (MI) is a life-threatening condition that necessitates multiple defibrillations. Catheter ablation is a potentially effective treatment strategy for VF storm refractory to optimal medical treatment. However, its impact on patient survival has not been verified in a large population. METHODS: We conducted a multicenter, retrospective observational study involving consecutive patients who underwent catheter ablation of post-MI refractory VF storm without preceding monomorphic ventricular tachycardia. The target of ablation was the Purkinje-related ventricular extrasystoles triggering VF. The primary outcome was in-hospital and long-term mortalities. Univariate logistic regression and Cox proportional-hazards analysis were used to evaluate clinical characteristics associated with in-hospital and long-term mortalities, respectively. RESULTS: One hundred ten patients were enrolled (age, 65±11years; 92 men; left ventricular ejection fraction, 31±10%). VF storm occurred at the acute phase of MI (4.5±2.5 days after the onset of MI during the index hospitalization for MI) in 43 patients (39%), the subacute phase (>1 week) in 48 (44%), and the remote phase (>6 months) in 19 (17%). The focal triggers were found to originate from the scar border zone in 88 patients (80%). During in-hospital stay after ablation, VF storm subsided in 92 patients (84%). Overall, 30 (27%) in-hospital deaths occurred. The duration from the VF occurrence to the ablation procedure was associated with in-hospital mortality (odds ratio for each 1-day increase, 1.11 [95% CI, 1.03-1.20]; P=0.008). During follow-up after discharge from hospital, only 1 patient developed recurrent VF storm. However, 29 patients (36%) died, with a median survival time of 2.2 years (interquartile range, 1.2-5.5 years). Long-term mortality was associated with left ventricular ejection fraction <30% (hazard ratio, 2.54 [95% CI, 1.21-5.32]; P=0.014), New York Heart Association class ≥III (hazard ratio, 2.68 [95% CI, 1.16-6.19]; P=0.021), a history of atrial fibrillation (hazard ratio, 3.89 [95% CI, 1.42-10.67]; P=0.008), and chronic kidney disease (hazard ratio, 2.74 [95% CI, 1.15-6.49]; P=0.023). CONCLUSIONS: In patients with MI presenting with focally triggered VF storm, catheter ablation of culprit triggers is lifesaving and appears to be associated with short- and long-term freedom from recurrent VF storm. Mortality over the long-term follow-up is associated with the severity of underlying cardiovascular disease and comorbidities in this specific patient population.
Authors: David E Krummen; Gordon Ho; Kurt S Hoffmayer; Franz N Schweis; Tina Baykaner; A J Rogers; Frederick T Han; Jonathan C Hsu; Mohan N Viswanathan; Paul J Wang; Wouter-Jan Rappel; Sanjiv M Narayan Journal: Circ Arrhythm Electrophysiol Date: 2021-02-07
Authors: Michel Haissaguerre; Ghassen Cheniti; Meleze Hocini; Frederic Sacher; F Daniel Ramirez; Hubert Cochet; Laura Bear; Romain Tixier; Josselin Duchateau; Rick Walton; Elodie Surget; Tsukasa Kamakura; Hugo Marchand; Nicolas Derval; Pierre Bordachar; Sylvain Ploux; Takamitsu Takagi; Thomas Pambrun; Pierre Jais; Louis Labrousse; Mark Strik; Hiroshi Ashikaga; Hugh Calkins; Ed Vigmond; Koonlawee Nademanee; Olivier Bernus; Remi Dubois Journal: Eur Heart J Date: 2022-03-21 Impact factor: 29.983
Authors: Vanessa Sciacca; Thomas Fink; Denise Guckel; Mustapha El Hamriti; Moneeb Khalaph; Martin Braun; Christian Sohns; Philipp Sommer; Guram Imnadze Journal: Front Cardiovasc Med Date: 2022-09-30