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 language | English (US) |
|---|---|
| Pages (from-to) | 132-141 |
| Number of pages | 10 |
| Journal | Journal of the American College of Cardiology |
| Volume | 60 |
| Issue number | 2 |
| DOIs | |
| State | Published - Jul 10 2012 |
| Externally published | Yes |
Fingerprint
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 journal › Article
}
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
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
UR - http://www.scopus.com/inward/record.url?scp=84863476213&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84863476213&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2012.03.044
DO - 10.1016/j.jacc.2012.03.044
M3 - Article
VL - 60
SP - 132
EP - 141
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 2
ER -