Radiofrequency ablation of drug refractory ventricular tachycardia related to cocaine use

A feasibility, safety, and efficacy study

Dhanunjaya Lakkireddy, Arun Kanmanthareddy, Mazda Biria, Yeruva Madhu Reddy, Jayasree Pillarisetti, Srijoy Mahapatra, Loren Berenbom, Larry Chinitz, Donita Atkins, Sudharani Bommana, Roderick Tung, Luigi Di Biase, Kalyanam Shivkumar, Andrea Natale

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

RF Ablation of VT in Chronic Cocaine Users Background Cocaine use is a known but rare cause of cardiac arrhythmias. Ventricular arrhythmias related to cocaine may not respond to antiarrhythmic drugs and may need treatment with radiofrequency ablation. Objectives We describe the clinical and electrophysiological characteristics of cocaine-related ventricular tachycardia (VT) from a multicenter registry. Methods Subjects presenting with VT related to cocaine use and being considered for radiofrequency ablation have been included in the study. Patients who were refractory to maximal medical therapy underwent radiofrequency ablation of the VT. Clinical, procedural variables, efficacy, and safety outcomes were assessed. Results A total of 14 subjects met study criteria (age 44 ± 13, range 18- to 68-year-old with 79% male, 71% Caucasian). MRI showed evidence of scar only in 43% of patients (6/14). The mechanism of VT was focal in 50% (n = 7) and scar related reentry in 50% (n = 7) based on 3D mapping. The mean VT cycle length was 429 ± 96 milliseconds. The site of origin was epicardial in 16% (3/18) of VTs. Most clinical VTs were hemodynamically stable (75%). Mean ejection fraction at the time of admission was 44 ± 14%. Duration of procedure was 289 ± 50 minutes. One subject developed pericardial tamponade requiring drainage. At 18 ± 11 months follow-up, freedom from arrhythmia was seen in 86% (1 case lost to follow-up and 2 died). Conclusion Radiofrequency ablation is not only feasible but also safe and effective in patients who have drug refractory VT related to chronic cocaine use.

Original languageEnglish (US)
Pages (from-to)739-746
Number of pages8
JournalJournal of Cardiovascular Electrophysiology
Volume25
Issue number7
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Ventricular Tachycardia
Cocaine
Safety
Pharmaceutical Preparations
Cardiac Arrhythmias
Cicatrix
Cardiac Tamponade
Anti-Arrhythmia Agents
Lost to Follow-Up
Registries
Drainage
Therapeutics

Keywords

  • cocaine
  • focal mechanism
  • myocardial infarction
  • reentry
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Lakkireddy, D., Kanmanthareddy, A., Biria, M., Madhu Reddy, Y., Pillarisetti, J., Mahapatra, S., ... Natale, A. (2014). Radiofrequency ablation of drug refractory ventricular tachycardia related to cocaine use: A feasibility, safety, and efficacy study. Journal of Cardiovascular Electrophysiology, 25(7), 739-746. https://doi.org/10.1111/jce.12432

Radiofrequency ablation of drug refractory ventricular tachycardia related to cocaine use : A feasibility, safety, and efficacy study. / Lakkireddy, Dhanunjaya; Kanmanthareddy, Arun; Biria, Mazda; Madhu Reddy, Yeruva; Pillarisetti, Jayasree; Mahapatra, Srijoy; Berenbom, Loren; Chinitz, Larry; Atkins, Donita; Bommana, Sudharani; Tung, Roderick; Di Biase, Luigi; Shivkumar, Kalyanam; Natale, Andrea.

In: Journal of Cardiovascular Electrophysiology, Vol. 25, No. 7, 2014, p. 739-746.

Research output: Contribution to journalArticle

Lakkireddy, D, Kanmanthareddy, A, Biria, M, Madhu Reddy, Y, Pillarisetti, J, Mahapatra, S, Berenbom, L, Chinitz, L, Atkins, D, Bommana, S, Tung, R, Di Biase, L, Shivkumar, K & Natale, A 2014, 'Radiofrequency ablation of drug refractory ventricular tachycardia related to cocaine use: A feasibility, safety, and efficacy study', Journal of Cardiovascular Electrophysiology, vol. 25, no. 7, pp. 739-746. https://doi.org/10.1111/jce.12432
Lakkireddy, Dhanunjaya ; Kanmanthareddy, Arun ; Biria, Mazda ; Madhu Reddy, Yeruva ; Pillarisetti, Jayasree ; Mahapatra, Srijoy ; Berenbom, Loren ; Chinitz, Larry ; Atkins, Donita ; Bommana, Sudharani ; Tung, Roderick ; Di Biase, Luigi ; Shivkumar, Kalyanam ; Natale, Andrea. / Radiofrequency ablation of drug refractory ventricular tachycardia related to cocaine use : A feasibility, safety, and efficacy study. In: Journal of Cardiovascular Electrophysiology. 2014 ; Vol. 25, No. 7. pp. 739-746.
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title = "Radiofrequency ablation of drug refractory ventricular tachycardia related to cocaine use: A feasibility, safety, and efficacy study",
abstract = "RF Ablation of VT in Chronic Cocaine Users Background Cocaine use is a known but rare cause of cardiac arrhythmias. Ventricular arrhythmias related to cocaine may not respond to antiarrhythmic drugs and may need treatment with radiofrequency ablation. Objectives We describe the clinical and electrophysiological characteristics of cocaine-related ventricular tachycardia (VT) from a multicenter registry. Methods Subjects presenting with VT related to cocaine use and being considered for radiofrequency ablation have been included in the study. Patients who were refractory to maximal medical therapy underwent radiofrequency ablation of the VT. Clinical, procedural variables, efficacy, and safety outcomes were assessed. Results A total of 14 subjects met study criteria (age 44 ± 13, range 18- to 68-year-old with 79{\%} male, 71{\%} Caucasian). MRI showed evidence of scar only in 43{\%} of patients (6/14). The mechanism of VT was focal in 50{\%} (n = 7) and scar related reentry in 50{\%} (n = 7) based on 3D mapping. The mean VT cycle length was 429 ± 96 milliseconds. The site of origin was epicardial in 16{\%} (3/18) of VTs. Most clinical VTs were hemodynamically stable (75{\%}). Mean ejection fraction at the time of admission was 44 ± 14{\%}. Duration of procedure was 289 ± 50 minutes. One subject developed pericardial tamponade requiring drainage. At 18 ± 11 months follow-up, freedom from arrhythmia was seen in 86{\%} (1 case lost to follow-up and 2 died). Conclusion Radiofrequency ablation is not only feasible but also safe and effective in patients who have drug refractory VT related to chronic cocaine use.",
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T1 - Radiofrequency ablation of drug refractory ventricular tachycardia related to cocaine use

T2 - A feasibility, safety, and efficacy study

AU - Lakkireddy, Dhanunjaya

AU - Kanmanthareddy, Arun

AU - Biria, Mazda

AU - Madhu Reddy, Yeruva

AU - Pillarisetti, Jayasree

AU - Mahapatra, Srijoy

AU - Berenbom, Loren

AU - Chinitz, Larry

AU - Atkins, Donita

AU - Bommana, Sudharani

AU - Tung, Roderick

AU - Di Biase, Luigi

AU - Shivkumar, Kalyanam

AU - Natale, Andrea

PY - 2014

Y1 - 2014

N2 - RF Ablation of VT in Chronic Cocaine Users Background Cocaine use is a known but rare cause of cardiac arrhythmias. Ventricular arrhythmias related to cocaine may not respond to antiarrhythmic drugs and may need treatment with radiofrequency ablation. Objectives We describe the clinical and electrophysiological characteristics of cocaine-related ventricular tachycardia (VT) from a multicenter registry. Methods Subjects presenting with VT related to cocaine use and being considered for radiofrequency ablation have been included in the study. Patients who were refractory to maximal medical therapy underwent radiofrequency ablation of the VT. Clinical, procedural variables, efficacy, and safety outcomes were assessed. Results A total of 14 subjects met study criteria (age 44 ± 13, range 18- to 68-year-old with 79% male, 71% Caucasian). MRI showed evidence of scar only in 43% of patients (6/14). The mechanism of VT was focal in 50% (n = 7) and scar related reentry in 50% (n = 7) based on 3D mapping. The mean VT cycle length was 429 ± 96 milliseconds. The site of origin was epicardial in 16% (3/18) of VTs. Most clinical VTs were hemodynamically stable (75%). Mean ejection fraction at the time of admission was 44 ± 14%. Duration of procedure was 289 ± 50 minutes. One subject developed pericardial tamponade requiring drainage. At 18 ± 11 months follow-up, freedom from arrhythmia was seen in 86% (1 case lost to follow-up and 2 died). Conclusion Radiofrequency ablation is not only feasible but also safe and effective in patients who have drug refractory VT related to chronic cocaine use.

AB - RF Ablation of VT in Chronic Cocaine Users Background Cocaine use is a known but rare cause of cardiac arrhythmias. Ventricular arrhythmias related to cocaine may not respond to antiarrhythmic drugs and may need treatment with radiofrequency ablation. Objectives We describe the clinical and electrophysiological characteristics of cocaine-related ventricular tachycardia (VT) from a multicenter registry. Methods Subjects presenting with VT related to cocaine use and being considered for radiofrequency ablation have been included in the study. Patients who were refractory to maximal medical therapy underwent radiofrequency ablation of the VT. Clinical, procedural variables, efficacy, and safety outcomes were assessed. Results A total of 14 subjects met study criteria (age 44 ± 13, range 18- to 68-year-old with 79% male, 71% Caucasian). MRI showed evidence of scar only in 43% of patients (6/14). The mechanism of VT was focal in 50% (n = 7) and scar related reentry in 50% (n = 7) based on 3D mapping. The mean VT cycle length was 429 ± 96 milliseconds. The site of origin was epicardial in 16% (3/18) of VTs. Most clinical VTs were hemodynamically stable (75%). Mean ejection fraction at the time of admission was 44 ± 14%. Duration of procedure was 289 ± 50 minutes. One subject developed pericardial tamponade requiring drainage. At 18 ± 11 months follow-up, freedom from arrhythmia was seen in 86% (1 case lost to follow-up and 2 died). Conclusion Radiofrequency ablation is not only feasible but also safe and effective in patients who have drug refractory VT related to chronic cocaine use.

KW - cocaine

KW - focal mechanism

KW - myocardial infarction

KW - reentry

KW - ventricular tachycardia

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