Drug-refractory ventricular tachycardias after myocarditis: Endocardial and epicardial radiofrequency catheter ablation

Antonio Dello Russo, Michela Casella, Maurizio Pieroni, Gemma Pelargonio, Stefano Bartoletti, Pasquale Santangeli, Martina Zucchetti, Ester Innocenti, Luigi Di Biase, Corrado Carbucicchio, Fulvio Bellocci, Cesare Fiorentini, Andrea Natale, Claudio Tondo

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background-Ventricular tachycardia (VT) is a significant therapeutic challenge in patients with myocarditis. This study aimed to assess the efficacy and safety of radiofrequency catheter ablation (RFCA) of VT in patients with myocarditis. Methods and Results-We enrolled 20 patients (15 men; age, 42 [28-52] years) with a history of biopsy- proven viral myocarditis and drug- refractory VT; 5 patients presented with electrical storm. The median left ventricular ejection fraction was 55% (45-60%). All patients underwent endocardial RFCA with an irrigated catheter, using contact electroanatomic mapping. Recurrence of sustained VT after endocardial RFCA was treated with additional epicardial RFCA. Endocardial RFCA was acutely successful in 14 patients (70%) while in the remaining 6 (30%) clinical VT was successfully ablated by epicardial RFCA. In 1 patient, hemodynamic instability required an intra- aortic balloon pump to complete RFCA. No major complication occurred during or after RFCA. Over a median follow- up time of 28 (11-48) months, 18 patients (90%) remained free of sustained VT; 2 patients (10%, both with baseline left ventricular ejection fraction ≤35%) died of acute heart failure unrelated to ventricular arrhythmias. Conclusions-In patients with myocarditis, RFCA of drug- refractory VT is feasible, safe, and effective. Epicardial RFCA should be considered as an important therapeutic option to increase success rate. (Circ Arrhythm Electrophysiol. 2012;5:492-498.)

Original languageEnglish (US)
Pages (from-to)492-498
Number of pages7
JournalCirculation: Arrhythmia and Electrophysiology
Volume5
Issue number3
DOIs
StatePublished - Jun 2012
Externally publishedYes

Fingerprint

Catheter Ablation
Myocarditis
Ventricular Tachycardia
Pharmaceutical Preparations
Stroke Volume
Cardiac Arrhythmias
Catheters
Heart Failure
Hemodynamics
Biopsy
Safety
Recurrence

Keywords

  • Catheter ablation
  • Myocarditis
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Drug-refractory ventricular tachycardias after myocarditis : Endocardial and epicardial radiofrequency catheter ablation. / Russo, Antonio Dello; Casella, Michela; Pieroni, Maurizio; Pelargonio, Gemma; Bartoletti, Stefano; Santangeli, Pasquale; Zucchetti, Martina; Innocenti, Ester; Di Biase, Luigi; Carbucicchio, Corrado; Bellocci, Fulvio; Fiorentini, Cesare; Natale, Andrea; Tondo, Claudio.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 5, No. 3, 06.2012, p. 492-498.

Research output: Contribution to journalArticle

Russo, AD, Casella, M, Pieroni, M, Pelargonio, G, Bartoletti, S, Santangeli, P, Zucchetti, M, Innocenti, E, Di Biase, L, Carbucicchio, C, Bellocci, F, Fiorentini, C, Natale, A & Tondo, C 2012, 'Drug-refractory ventricular tachycardias after myocarditis: Endocardial and epicardial radiofrequency catheter ablation', Circulation: Arrhythmia and Electrophysiology, vol. 5, no. 3, pp. 492-498. https://doi.org/10.1161/CIRCEP.111.965012
Russo, Antonio Dello ; Casella, Michela ; Pieroni, Maurizio ; Pelargonio, Gemma ; Bartoletti, Stefano ; Santangeli, Pasquale ; Zucchetti, Martina ; Innocenti, Ester ; Di Biase, Luigi ; Carbucicchio, Corrado ; Bellocci, Fulvio ; Fiorentini, Cesare ; Natale, Andrea ; Tondo, Claudio. / Drug-refractory ventricular tachycardias after myocarditis : Endocardial and epicardial radiofrequency catheter ablation. In: Circulation: Arrhythmia and Electrophysiology. 2012 ; Vol. 5, No. 3. pp. 492-498.
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abstract = "Background-Ventricular tachycardia (VT) is a significant therapeutic challenge in patients with myocarditis. This study aimed to assess the efficacy and safety of radiofrequency catheter ablation (RFCA) of VT in patients with myocarditis. Methods and Results-We enrolled 20 patients (15 men; age, 42 [28-52] years) with a history of biopsy- proven viral myocarditis and drug- refractory VT; 5 patients presented with electrical storm. The median left ventricular ejection fraction was 55{\%} (45-60{\%}). All patients underwent endocardial RFCA with an irrigated catheter, using contact electroanatomic mapping. Recurrence of sustained VT after endocardial RFCA was treated with additional epicardial RFCA. Endocardial RFCA was acutely successful in 14 patients (70{\%}) while in the remaining 6 (30{\%}) clinical VT was successfully ablated by epicardial RFCA. In 1 patient, hemodynamic instability required an intra- aortic balloon pump to complete RFCA. No major complication occurred during or after RFCA. Over a median follow- up time of 28 (11-48) months, 18 patients (90{\%}) remained free of sustained VT; 2 patients (10{\%}, both with baseline left ventricular ejection fraction ≤35{\%}) died of acute heart failure unrelated to ventricular arrhythmias. Conclusions-In patients with myocarditis, RFCA of drug- refractory VT is feasible, safe, and effective. Epicardial RFCA should be considered as an important therapeutic option to increase success rate. (Circ Arrhythm Electrophysiol. 2012;5:492-498.)",
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T1 - Drug-refractory ventricular tachycardias after myocarditis

T2 - Endocardial and epicardial radiofrequency catheter ablation

AU - Russo, Antonio Dello

AU - Casella, Michela

AU - Pieroni, Maurizio

AU - Pelargonio, Gemma

AU - Bartoletti, Stefano

AU - Santangeli, Pasquale

AU - Zucchetti, Martina

AU - Innocenti, Ester

AU - Di Biase, Luigi

AU - Carbucicchio, Corrado

AU - Bellocci, Fulvio

AU - Fiorentini, Cesare

AU - Natale, Andrea

AU - Tondo, Claudio

PY - 2012/6

Y1 - 2012/6

N2 - Background-Ventricular tachycardia (VT) is a significant therapeutic challenge in patients with myocarditis. This study aimed to assess the efficacy and safety of radiofrequency catheter ablation (RFCA) of VT in patients with myocarditis. Methods and Results-We enrolled 20 patients (15 men; age, 42 [28-52] years) with a history of biopsy- proven viral myocarditis and drug- refractory VT; 5 patients presented with electrical storm. The median left ventricular ejection fraction was 55% (45-60%). All patients underwent endocardial RFCA with an irrigated catheter, using contact electroanatomic mapping. Recurrence of sustained VT after endocardial RFCA was treated with additional epicardial RFCA. Endocardial RFCA was acutely successful in 14 patients (70%) while in the remaining 6 (30%) clinical VT was successfully ablated by epicardial RFCA. In 1 patient, hemodynamic instability required an intra- aortic balloon pump to complete RFCA. No major complication occurred during or after RFCA. Over a median follow- up time of 28 (11-48) months, 18 patients (90%) remained free of sustained VT; 2 patients (10%, both with baseline left ventricular ejection fraction ≤35%) died of acute heart failure unrelated to ventricular arrhythmias. Conclusions-In patients with myocarditis, RFCA of drug- refractory VT is feasible, safe, and effective. Epicardial RFCA should be considered as an important therapeutic option to increase success rate. (Circ Arrhythm Electrophysiol. 2012;5:492-498.)

AB - Background-Ventricular tachycardia (VT) is a significant therapeutic challenge in patients with myocarditis. This study aimed to assess the efficacy and safety of radiofrequency catheter ablation (RFCA) of VT in patients with myocarditis. Methods and Results-We enrolled 20 patients (15 men; age, 42 [28-52] years) with a history of biopsy- proven viral myocarditis and drug- refractory VT; 5 patients presented with electrical storm. The median left ventricular ejection fraction was 55% (45-60%). All patients underwent endocardial RFCA with an irrigated catheter, using contact electroanatomic mapping. Recurrence of sustained VT after endocardial RFCA was treated with additional epicardial RFCA. Endocardial RFCA was acutely successful in 14 patients (70%) while in the remaining 6 (30%) clinical VT was successfully ablated by epicardial RFCA. In 1 patient, hemodynamic instability required an intra- aortic balloon pump to complete RFCA. No major complication occurred during or after RFCA. Over a median follow- up time of 28 (11-48) months, 18 patients (90%) remained free of sustained VT; 2 patients (10%, both with baseline left ventricular ejection fraction ≤35%) died of acute heart failure unrelated to ventricular arrhythmias. Conclusions-In patients with myocarditis, RFCA of drug- refractory VT is feasible, safe, and effective. Epicardial RFCA should be considered as an important therapeutic option to increase success rate. (Circ Arrhythm Electrophysiol. 2012;5:492-498.)

KW - Catheter ablation

KW - Myocarditis

KW - Ventricular tachycardia

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