TY - JOUR
T1 - High-density substrate-guided ventricular tachycardia ablation
T2 - Role of activation mapping in an attempt to improve procedural effectiveness
AU - Carbucicchio, Corrado
AU - Ahmad Raja, Nadeem
AU - Di Biase, Luigi
AU - Volpe, Valeria
AU - Dello Russo, Antonio
AU - Trivedi, Chintan
AU - Bartoletti, Stefano
AU - Zucchetti, Martina
AU - Casella, Michela
AU - Russo, Eleonora
AU - Santangeli, Pasquale
AU - Moltrasio, Massimo
AU - Tundo, Fabrizio
AU - Fassini, Gaetano
AU - Natale, Andrea
AU - Tondo, Claudio
N1 - Funding Information:
Dr Carbucicchio is a consultant for Biotronik. Dr Di Biase is a consultant for Hansen Medical and Biosense Webster. Dr Dello Russo is a consultant for Biosense Webster. Dr Natale has received speaker honoraria from Boston Scientific, Biosense Webster, St Jude Medical, Medtronic, and Life Watch as well as a research grant from St Jude Medical. Dr Tondo is part of the advisory board of Medtronic and Biotronik; he has received lecture fees from St Jude Medical, Biosense Webster, and Boston Scientific.
PY - 2013/12
Y1 - 2013/12
N2 - Background Advanced techniques of electroanatomical mapping efficiently guide ventricular tachycardia (VT) ablation strategies; in this context, the adjunctive value of combining activation mapping (AMap) to improve accuracy has not been elucidated. Objective To investigate whether conventional AMap further contributes to the identification of critical sites of VT reentry and whether this translates into a more effective ablation outcome in a cohort of patients undergoing VT ablation. Methods We prospectively enrolled 126 patients (mean age 65.3 ± 10.5 years; left ventricular ejection fraction 33.3% ± 7.2%) with ischemic (n = 89) or idiopathic (n = 37) dilated cardiomyopathy undergoing endocardial (n = 105) or endo-epicardial (n = 21) electroanatomical mapping and ablation. A substrate-guided strategy targeting surrogate markers of reentry was accomplished in all patients, but the feasibility and efficacy of AMap was preliminarily assessed for all induced VTs focusing on early VT suppression obtained during radiofrequency delivery. VT-free survival was assessed by ICD interrogation. Results AMap successfully guided ablation in 62 of 104 (59.6%) patients with inducible VT(s). At 1 year, 6 of 126 (4.8%) patients died; VT recurred in 28 of 126 (22.2%) patients. No significant difference in VT recurrence rate was observed between patients in whom AMap proved effective versus those in whom substrate-guided ablation was not corroborated by AMap (16 of 62 [25.8%] vs 12 of 64 [18.8%]; log-rank test, P =.3). Conclusions Our findings support the efficacy of a substrate-guided strategy targeting specific markers of arrhythmogenicity identified during sinus rhythm. AMap proves highly efficient acutely but does not improve overall VT-free survival, suggesting that in patients with advanced cardiac disease, life-threatening arrhythmias can be successfully treated by ablation in sinus rhythm, thus limiting procedural risks.
AB - Background Advanced techniques of electroanatomical mapping efficiently guide ventricular tachycardia (VT) ablation strategies; in this context, the adjunctive value of combining activation mapping (AMap) to improve accuracy has not been elucidated. Objective To investigate whether conventional AMap further contributes to the identification of critical sites of VT reentry and whether this translates into a more effective ablation outcome in a cohort of patients undergoing VT ablation. Methods We prospectively enrolled 126 patients (mean age 65.3 ± 10.5 years; left ventricular ejection fraction 33.3% ± 7.2%) with ischemic (n = 89) or idiopathic (n = 37) dilated cardiomyopathy undergoing endocardial (n = 105) or endo-epicardial (n = 21) electroanatomical mapping and ablation. A substrate-guided strategy targeting surrogate markers of reentry was accomplished in all patients, but the feasibility and efficacy of AMap was preliminarily assessed for all induced VTs focusing on early VT suppression obtained during radiofrequency delivery. VT-free survival was assessed by ICD interrogation. Results AMap successfully guided ablation in 62 of 104 (59.6%) patients with inducible VT(s). At 1 year, 6 of 126 (4.8%) patients died; VT recurred in 28 of 126 (22.2%) patients. No significant difference in VT recurrence rate was observed between patients in whom AMap proved effective versus those in whom substrate-guided ablation was not corroborated by AMap (16 of 62 [25.8%] vs 12 of 64 [18.8%]; log-rank test, P =.3). Conclusions Our findings support the efficacy of a substrate-guided strategy targeting specific markers of arrhythmogenicity identified during sinus rhythm. AMap proves highly efficient acutely but does not improve overall VT-free survival, suggesting that in patients with advanced cardiac disease, life-threatening arrhythmias can be successfully treated by ablation in sinus rhythm, thus limiting procedural risks.
KW - Catheter ablation
KW - Electroanatomical mapping
KW - Ischemic heart disease
KW - Nonischemic cardiomyopathy
KW - Ventricular tachycardia
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U2 - 10.1016/j.hrthm.2013.09.059
DO - 10.1016/j.hrthm.2013.09.059
M3 - Article
C2 - 24055940
AN - SCOPUS:84889781070
SN - 1547-5271
VL - 10
SP - 1850
EP - 1858
JO - Heart Rhythm
JF - Heart Rhythm
IS - 12
ER -