TY - JOUR
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
N1 - Funding Information:
Drs. Di Biase and Santangeli are co-first authors. Dr. Bai was supported from China by the Program for New Century Excellent Talents in University ( NCET-09-0376 ); the National Natural Science Foundation ( NSFC-30700297 and 30973601 ) and the Scientific Research Foundation for the Returned Overseas Chinese Scholars ( SFR ROCS 2008-101 ). Dr. Di Biase is a consultant for Hansen Medical and Biosense Webster. Dr. Natale received speaker honorariums from Boston Scientific, Biosense Webster, St. Jude Medical, Biotronik, and Life Watch. Dr. Tondo is a member of the advisory boards of Medtronic and Biotronik; and receives lecture fees from St. Jude Medical and Biotronik. Dr. Burkhardt is a consultant to Stereotaxis and Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Preliminary results of this study were presented as an oral abstract presentation at the American Heart Association Scientific Session 2010 by Dr. Di Biase.
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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U2 - 10.1016/j.jacc.2012.03.044
DO - 10.1016/j.jacc.2012.03.044
M3 - Article
C2 - 22766340
AN - SCOPUS:84863476213
SN - 0735-1097
VL - 60
SP - 132
EP - 141
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 2
ER -