Endo-epicardial homogenization of the scar versus limited substrate ablation for the treatment of electrical storms in patients with ischemic cardiomyopathy

Luigi Di Biase, Pasquale Santangeli, David J. Burkhardt, Rong Bai, Prasant Mohanty, Corrado Carbucicchio, Antonio Dello Russo, Michela Casella, Sanghamitra Mohanty, Agnes Pump, Richard Hongo, Salwa Beheiry, Gemma Pelargonio, Pietro Santarelli, Martina Zucchetti, Rodney Horton, Javier E. Sanchez, Claude S. Elayi, Dhanunjay Lakkireddy, Claudio Tondo & 1 others Andrea Natale

Research output: Contribution to journalArticle

196 Citations (Scopus)

Abstract

Objectives: This study investigated the impact on recurrences of 2 different substrate approaches for the treatment of these arrhythmias. Background: Catheter ablation of electrical storms (ES) for ventricular arrhythmias (VAs) has shown moderate long-term efficacy in patients with ischemic cardiomyopathy. Methods: Ninety-two consecutive patients (81% male, age 62 ± 13 years) with ischemic cardiomyopathy and ES underwent catheter ablation. Patients were treated either by confining the radiofrequency lesions to the endocardial surface with limited substrate ablation (Group 1, n = 49) or underwent endocardial and epicardial ablation of abnormal potentials within the scar (homogenization of the scar, Group 2, n = 43). Epicardial access was obtained in all Group 2 patients, whereas epicardial ablation was performed in 33% (14) of these patients. Results: Mean ejection fraction was 27 ± 5. During a mean follow-up of 25 ± 10 months, the VAs recurrence rate of any ventricular tachycardia (VTs) was 47% (23 of 49 patients) in Group 1 and 19% (8 of 43 patients) in Group 2 (log-rank p = 0.006). One patient in Group 1 and 1 patient in Group 2 died at follow-up for noncardiac reasons. Conclusions: Our study demonstrates that ablation using endo-epicardial homogenization of the scar significantly increases freedom from VAs in ischemic cardiomyopathy patients.

Original languageEnglish (US)
Pages (from-to)132-141
Number of pages10
JournalJournal of the American College of Cardiology
Volume60
Issue number2
DOIs
StatePublished - Jul 10 2012
Externally publishedYes

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Cardiomyopathies
Cicatrix
Cardiac Arrhythmias
Therapeutics
Catheter Ablation
Recurrence
Ventricular Tachycardia

Keywords

  • catheter ablation
  • electrical storm
  • electrophysiology
  • epicardial
  • irrigated tip catheter
  • ischemic cardiomyopathy
  • mapping
  • myocardial infarction
  • scar
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Endo-epicardial homogenization of the scar versus limited substrate ablation for the treatment of electrical storms in patients with ischemic cardiomyopathy. / Di Biase, Luigi; Santangeli, Pasquale; Burkhardt, David J.; Bai, Rong; Mohanty, Prasant; Carbucicchio, Corrado; Dello Russo, Antonio; Casella, Michela; Mohanty, Sanghamitra; Pump, Agnes; Hongo, Richard; Beheiry, Salwa; Pelargonio, Gemma; Santarelli, Pietro; Zucchetti, Martina; Horton, Rodney; Sanchez, Javier E.; Elayi, Claude S.; Lakkireddy, Dhanunjay; Tondo, Claudio; Natale, Andrea.

In: Journal of the American College of Cardiology, Vol. 60, No. 2, 10.07.2012, p. 132-141.

Research output: Contribution to journalArticle

Di Biase, L, Santangeli, P, Burkhardt, DJ, Bai, R, Mohanty, P, Carbucicchio, C, Dello Russo, A, Casella, M, Mohanty, S, Pump, A, Hongo, R, Beheiry, S, Pelargonio, G, Santarelli, P, Zucchetti, M, Horton, R, Sanchez, JE, Elayi, CS, Lakkireddy, D, Tondo, C & Natale, A 2012, 'Endo-epicardial homogenization of the scar versus limited substrate ablation for the treatment of electrical storms in patients with ischemic cardiomyopathy', Journal of the American College of Cardiology, vol. 60, no. 2, pp. 132-141. https://doi.org/10.1016/j.jacc.2012.03.044
Di Biase, Luigi ; Santangeli, Pasquale ; Burkhardt, David J. ; Bai, Rong ; Mohanty, Prasant ; Carbucicchio, Corrado ; Dello Russo, Antonio ; Casella, Michela ; Mohanty, Sanghamitra ; Pump, Agnes ; Hongo, Richard ; Beheiry, Salwa ; Pelargonio, Gemma ; Santarelli, Pietro ; Zucchetti, Martina ; Horton, Rodney ; Sanchez, Javier E. ; Elayi, Claude S. ; Lakkireddy, Dhanunjay ; Tondo, Claudio ; Natale, Andrea. / Endo-epicardial homogenization of the scar versus limited substrate ablation for the treatment of electrical storms in patients with ischemic cardiomyopathy. In: Journal of the American College of Cardiology. 2012 ; Vol. 60, No. 2. pp. 132-141.
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abstract = "Objectives: This study investigated the impact on recurrences of 2 different substrate approaches for the treatment of these arrhythmias. Background: Catheter ablation of electrical storms (ES) for ventricular arrhythmias (VAs) has shown moderate long-term efficacy in patients with ischemic cardiomyopathy. Methods: Ninety-two consecutive patients (81{\%} male, age 62 ± 13 years) with ischemic cardiomyopathy and ES underwent catheter ablation. Patients were treated either by confining the radiofrequency lesions to the endocardial surface with limited substrate ablation (Group 1, n = 49) or underwent endocardial and epicardial ablation of abnormal potentials within the scar (homogenization of the scar, Group 2, n = 43). Epicardial access was obtained in all Group 2 patients, whereas epicardial ablation was performed in 33{\%} (14) of these patients. Results: Mean ejection fraction was 27 ± 5. During a mean follow-up of 25 ± 10 months, the VAs recurrence rate of any ventricular tachycardia (VTs) was 47{\%} (23 of 49 patients) in Group 1 and 19{\%} (8 of 43 patients) in Group 2 (log-rank p = 0.006). One patient in Group 1 and 1 patient in Group 2 died at follow-up for noncardiac reasons. Conclusions: Our study demonstrates that ablation using endo-epicardial homogenization of the scar significantly increases freedom from VAs in ischemic cardiomyopathy patients.",
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T1 - Endo-epicardial homogenization of the scar versus limited substrate ablation for the treatment of electrical storms in patients with ischemic cardiomyopathy

AU - Di Biase, Luigi

AU - Santangeli, Pasquale

AU - Burkhardt, David J.

AU - Bai, Rong

AU - Mohanty, Prasant

AU - Carbucicchio, Corrado

AU - Dello Russo, Antonio

AU - Casella, Michela

AU - Mohanty, Sanghamitra

AU - Pump, Agnes

AU - Hongo, Richard

AU - Beheiry, Salwa

AU - Pelargonio, Gemma

AU - Santarelli, Pietro

AU - Zucchetti, Martina

AU - Horton, Rodney

AU - Sanchez, Javier E.

AU - Elayi, Claude S.

AU - Lakkireddy, Dhanunjay

AU - Tondo, Claudio

AU - Natale, Andrea

PY - 2012/7/10

Y1 - 2012/7/10

N2 - Objectives: This study investigated the impact on recurrences of 2 different substrate approaches for the treatment of these arrhythmias. Background: Catheter ablation of electrical storms (ES) for ventricular arrhythmias (VAs) has shown moderate long-term efficacy in patients with ischemic cardiomyopathy. Methods: Ninety-two consecutive patients (81% male, age 62 ± 13 years) with ischemic cardiomyopathy and ES underwent catheter ablation. Patients were treated either by confining the radiofrequency lesions to the endocardial surface with limited substrate ablation (Group 1, n = 49) or underwent endocardial and epicardial ablation of abnormal potentials within the scar (homogenization of the scar, Group 2, n = 43). Epicardial access was obtained in all Group 2 patients, whereas epicardial ablation was performed in 33% (14) of these patients. Results: Mean ejection fraction was 27 ± 5. During a mean follow-up of 25 ± 10 months, the VAs recurrence rate of any ventricular tachycardia (VTs) was 47% (23 of 49 patients) in Group 1 and 19% (8 of 43 patients) in Group 2 (log-rank p = 0.006). One patient in Group 1 and 1 patient in Group 2 died at follow-up for noncardiac reasons. Conclusions: Our study demonstrates that ablation using endo-epicardial homogenization of the scar significantly increases freedom from VAs in ischemic cardiomyopathy patients.

AB - Objectives: This study investigated the impact on recurrences of 2 different substrate approaches for the treatment of these arrhythmias. Background: Catheter ablation of electrical storms (ES) for ventricular arrhythmias (VAs) has shown moderate long-term efficacy in patients with ischemic cardiomyopathy. Methods: Ninety-two consecutive patients (81% male, age 62 ± 13 years) with ischemic cardiomyopathy and ES underwent catheter ablation. Patients were treated either by confining the radiofrequency lesions to the endocardial surface with limited substrate ablation (Group 1, n = 49) or underwent endocardial and epicardial ablation of abnormal potentials within the scar (homogenization of the scar, Group 2, n = 43). Epicardial access was obtained in all Group 2 patients, whereas epicardial ablation was performed in 33% (14) of these patients. Results: Mean ejection fraction was 27 ± 5. During a mean follow-up of 25 ± 10 months, the VAs recurrence rate of any ventricular tachycardia (VTs) was 47% (23 of 49 patients) in Group 1 and 19% (8 of 43 patients) in Group 2 (log-rank p = 0.006). One patient in Group 1 and 1 patient in Group 2 died at follow-up for noncardiac reasons. Conclusions: Our study demonstrates that ablation using endo-epicardial homogenization of the scar significantly increases freedom from VAs in ischemic cardiomyopathy patients.

KW - catheter ablation

KW - electrical storm

KW - electrophysiology

KW - epicardial

KW - irrigated tip catheter

KW - ischemic cardiomyopathy

KW - mapping

KW - myocardial infarction

KW - scar

KW - ventricular tachycardia

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JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

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