Efficacy and safety of combined endocardial/epicardial catheter ablation for ventricular tachycardia in Chagas disease: A randomized controlled study

Cristiano F. Pisani, Jorge Romero, Sissy Lara, Carina Hardy, Muhieddine Chokr, Luciana Sacilotto, Tan Chen Wu, Francisco Darrieux, Denise Hachul, Roberto Kalil-Filho, Luigi Di Biase, Mauricio Scanavacca

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Background: Epicardial mapping and ablation are frequently necessary to eliminate ventricular tachycardia (VT) in patients with Chagas disease. Nonetheless, there are no randomized controlled trials demonstrating the role of this strategy. Objective: We conducted this randomized controlled trial to evaluate the efficacy and safety of combined epicardial ablation in patients with Chagas disease. Methods: We randomized patients with Chagas disease and VT in a 1:1 fashion to either the endocardial (endo) mapping and ablation group or the combined endocardial/epicardial (endo/epi) mapping and ablation group. The efficacy end points were measured by VT inducibility and all-ventricular arrhythmia recurrence. Safety was assessed by the rate of periprocedural complications. Results: Thirty patients were enrolled, and most were male. The median age was 67 (Q1: 58; Q3: 70) years in the endo group and 58 (Q1: 43; Q3: 66) years in the endo/epi group. The left ventricular ejection fraction was 33.0% ± 9.5% and 35.2% ± 11.5%, respectively P =.13. Acute success (non-reinducibility of clinical VT) was obtained in 13 patients (86%) in the endo/epi group and in 6 patients (40%) in the endo-only group (P =.021). There were 12 patients with VT recurrence (80%) in the endo-only group and 6 patients (40%) in the endo/epi group (P =.02) (by intention-to-treat analysis). Epicardial ablation was ultimately performed in 9 patients (60%) in the endo-only group because of an absence of endocardial scar or maintenance of VT inducibility. There was no difference in complications between the groups. Conclusion: Combining endo/epi VT catheter ablation in patients with Chagas disease significantly increases short- and long-term freedom from all-ventricular arrhythmias. Epicardial access did not increase periprocedural complication rates.

Original languageEnglish (US)
Pages (from-to)1510-1518
Number of pages9
JournalHeart Rhythm
Volume17
Issue number9
DOIs
StatePublished - Sep 2020

Keywords

  • Catheter ablation
  • Chagas disease
  • Endocardial ablation
  • Epicardial mapping
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Fingerprint Dive into the research topics of 'Efficacy and safety of combined endocardial/epicardial catheter ablation for ventricular tachycardia in Chagas disease: A randomized controlled study'. Together they form a unique fingerprint.

  • Cite this

    Pisani, C. F., Romero, J., Lara, S., Hardy, C., Chokr, M., Sacilotto, L., Wu, T. C., Darrieux, F., Hachul, D., Kalil-Filho, R., Di Biase, L., & Scanavacca, M. (2020). Efficacy and safety of combined endocardial/epicardial catheter ablation for ventricular tachycardia in Chagas disease: A randomized controlled study. Heart Rhythm, 17(9), 1510-1518. https://doi.org/10.1016/j.hrthm.2020.02.009