TY - JOUR
T1 - Electrophysiologic Substrate, Safety, Procedural Approaches, and Outcomes of Catheter Ablation for Ventricular Tachycardia in Patients After Aortic Valve Replacement
AU - Liang, Jackson J.
AU - Castro, Simon A.
AU - Muser, Daniele
AU - Briceno, David F.
AU - Shirai, Yasuhiro
AU - Enriquez, Andres
AU - Kumareswaran, Ramanan
AU - Santangeli, Pasquale
AU - Zado, Erica S.
AU - Arkles, Jeffrey S.
AU - Schaller, Robert D.
AU - Supple, Gregory E.
AU - Frankel, David S.
AU - Nazarian, Saman
AU - Riley, Michael P.
AU - Garcia, Fermin C.
AU - Lin, David
AU - Dixit, Sanjay
AU - Callans, David J.
AU - Marchlinski, Francis E.
N1 - Publisher Copyright:
© 2019 American College of Cardiology Foundation
PY - 2019/1
Y1 - 2019/1
N2 - Objectives: This study sought to investigate the substrate, procedural strategies, safety, and outcomes of catheter ablation (CA) for ventricular tachycardia (VT) in patients with aortic valve replacement (AVR). Background: VT ablation in patients with AVR is challenging, particularly when mapping and ablation in the periaortic region are necessary. Methods: We identified consecutive patients with mechanical, bioprosthetic, and transcatheter AVR who underwent CA for VT refractory to antiarrhythmic drugs and analyzed VT substrate, approach to LV access, complications, and long-term outcomes. Results: Overall, 29 patients (87% men, mean age 67.9 ± 9.8 years, left ventricular ejection fraction 39 ± 10%) with prior AVR (13 mechanical, 15 bioprosthetic, 1 transcatheter AVR) underwent 40 ablations from 2004 to 2016. Left-sided mapping/CA was performed in 27 patients (36 procedures). Access was retrograde aortic in 11 procedures (all bioprosthetic), transseptal in 24 (13 mechanical; 10 bioprosthetic; 1 transcatheter AVR), or transventricular septal in 1. Periaortic bipolar or unipolar scar was detected in all 24 patients in whom detailed periaortic mapping was performed. Clinical VT circuit(s) involved the periaortic region in 10 patients (34%), 2 (7%) had bundle branch re-entry VT, and 17 (59%) had substrate unrelated to AVR. There were 2 major complications (both related to vascular access). Only 2 patients (9.1%) had VT recurrence. Over median follow-up of 12.8 months, 11 patients died (none as a result of recurrent VT). Conclusions: Whereas most patients undergoing CA for VT after AVR had VT from substrate unrelated to AVR, periaortic scar is universally present and bundle branch re-entry can be the VT mechanism. CA can be safely performed with excellent long-term VT elimination.
AB - Objectives: This study sought to investigate the substrate, procedural strategies, safety, and outcomes of catheter ablation (CA) for ventricular tachycardia (VT) in patients with aortic valve replacement (AVR). Background: VT ablation in patients with AVR is challenging, particularly when mapping and ablation in the periaortic region are necessary. Methods: We identified consecutive patients with mechanical, bioprosthetic, and transcatheter AVR who underwent CA for VT refractory to antiarrhythmic drugs and analyzed VT substrate, approach to LV access, complications, and long-term outcomes. Results: Overall, 29 patients (87% men, mean age 67.9 ± 9.8 years, left ventricular ejection fraction 39 ± 10%) with prior AVR (13 mechanical, 15 bioprosthetic, 1 transcatheter AVR) underwent 40 ablations from 2004 to 2016. Left-sided mapping/CA was performed in 27 patients (36 procedures). Access was retrograde aortic in 11 procedures (all bioprosthetic), transseptal in 24 (13 mechanical; 10 bioprosthetic; 1 transcatheter AVR), or transventricular septal in 1. Periaortic bipolar or unipolar scar was detected in all 24 patients in whom detailed periaortic mapping was performed. Clinical VT circuit(s) involved the periaortic region in 10 patients (34%), 2 (7%) had bundle branch re-entry VT, and 17 (59%) had substrate unrelated to AVR. There were 2 major complications (both related to vascular access). Only 2 patients (9.1%) had VT recurrence. Over median follow-up of 12.8 months, 11 patients died (none as a result of recurrent VT). Conclusions: Whereas most patients undergoing CA for VT after AVR had VT from substrate unrelated to AVR, periaortic scar is universally present and bundle branch re-entry can be the VT mechanism. CA can be safely performed with excellent long-term VT elimination.
KW - aortic valve replacement
KW - cardiomyopathy
KW - catheter ablation
KW - safety
KW - ventricular tachycardia
UR - http://www.scopus.com/inward/record.url?scp=85060038150&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85060038150&partnerID=8YFLogxK
U2 - 10.1016/j.jacep.2018.08.008
DO - 10.1016/j.jacep.2018.08.008
M3 - Article
C2 - 30678784
AN - SCOPUS:85060038150
SN - 2405-500X
VL - 5
SP - 28
EP - 38
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 1
ER -