TY - JOUR
T1 - Efficacy and safety of combined endocardial/epicardial catheter ablation for ventricular tachycardia in Chagas disease
T2 - A randomized controlled study
AU - Pisani, Cristiano F.
AU - Romero, Jorge
AU - Lara, Sissy
AU - Hardy, Carina
AU - Chokr, Muhieddine
AU - Sacilotto, Luciana
AU - Wu, Tan Chen
AU - Darrieux, Francisco
AU - Hachul, Denise
AU - Kalil-Filho, Roberto
AU - Di Biase, Luigi
AU - Scanavacca, Mauricio
N1 - Publisher Copyright:
© 2020 Heart Rhythm Society
PY - 2020/9
Y1 - 2020/9
N2 - 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.
AB - 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.
KW - Catheter ablation
KW - Chagas disease
KW - Endocardial ablation
KW - Epicardial mapping
KW - Ventricular tachycardia
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U2 - 10.1016/j.hrthm.2020.02.009
DO - 10.1016/j.hrthm.2020.02.009
M3 - Article
C2 - 32087356
AN - SCOPUS:85087414824
SN - 1547-5271
VL - 17
SP - 1510
EP - 1518
JO - Heart Rhythm
JF - Heart Rhythm
IS - 9
ER -