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  • 1
    Online Resource
    Online Resource
    Catheter Ablation of Ventricular Arrhythmia in Nonischemic Cardiomyopathy : Anteroseptal Versus Inferolateral Scar Sub-Types
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Circulation: Arrhythmia and Electrophysiology Vol. 7, No. 3 ( 2014-06), p. 414-423
    Details
    In: Circulation: Arrhythmia and Electrophysiology, Ovid Technologies (Wolters Kluwer Health), Vol. 7, No. 3 ( 2014-06), p. 414-423
    Abstract: The aim was to relate distinct scar distributions found in nonischemic cardiomyopathy with ventricular tachycardia (VT) morphology, late potential distribution, ablation strategy, and outcome. Methods and Results— Eighty-seven patients underwent catheter ablation for drug-refractory VT. Based on endocardial unipolar voltage, 44 were classified as predominantly anteroseptal and 43 as inferolateral. Anteroseptal patients more frequently fulfilled diagnostic criteria for dilated cardiomyopathy (64% versus 36%), associated with more extensive endocardial unipolar scar (41 [22–83] versus 9 [1–29] cm 2 ; P 〈 0.001). Left inferior VT axis was predictive of anteroseptal scar (positive predictive value, 100%) and right superior axis for inferolateral (positive predictive value, 89%). Late potentials were infrequent in the anteroseptal group (11% versus 74%; P 〈 0.001). Epicardial late potentials were common in the inferolateral group (81% versus 4%; P 〈 0.001) and correlated with VT termination sites (κ=0.667; P =0.014), whereas no anteroseptal patient had an epicardial VT termination ( P 〈 0.001). VT recurred in 44 patients (51%) during a median follow-up of 1.5 years. Anteroseptal scar was associated with higher VT recurrence (74% versus 25%; log-rank P 〈 0.001) and redo procedure rates (59% versus 7%; log-rank P 〈 0.001). After multivariable analysis, clinical predictors of VT recurrence were electrical storm (hazard ratio, 3.211; P =0.001) and New York Heart Association class (hazard ratio, 1.608; P =0.018); the only procedural predictor of VT recurrence was anteroseptal scar pattern (hazard ratio, 5.547; P 〈 0.001). Conclusions— Unipolar low-voltage distribution in nonischemic cardiomyopathy allows categorization of scar pattern as inferolateral, often requiring epicardial ablation mainly based on late potentials, and anteroseptal, which frequently involves an intramural septal substrate, leading to a higher VT recurrence.
    Type of Medium: Online Resource
    ISSN: 1941-3149 , 1941-3084
    URL: Article
    DOI: 10.1161/CIRCEP.114.001568
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 2425487-3
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  • 2
    Online Resource
    Online Resource
    Noninducibility and Late Potential Abolition : A Novel Combined Prognostic Procedural End Point for Catheter Ablation of Postinfarction Ventricular Tachycardia
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Circulation: Arrhythmia and Electrophysiology Vol. 7, No. 3 ( 2014-06), p. 424-435
    Details
    In: Circulation: Arrhythmia and Electrophysiology, Ovid Technologies (Wolters Kluwer Health), Vol. 7, No. 3 ( 2014-06), p. 424-435
    Abstract: Successful late potential (LP) abolition and postprocedural ventricular tachycardia (VT) noninducibility constitute significant end points after catheter ablation for VT. We investigated the prognostic impact of a combined procedural end point of VT noninducibility and LP abolition in a large series of post–myocardial infarction patients with VT. Methods and Results— A total of 160 (154 men, 94% with implantable cardioverter defibrillators) consecutive post–myocardial infarction patients undergoing first-time ablation procedures from 2010 to 2012 were included. Of the 159 patients surviving the procedure, 137 (86%) were either inducible or in VT at baseline and 103 (65%) had baseline LP presence, of which 79 (77%) underwent successful LP abolition. The combined end point was assessable in 155 (97%) patients. There were 50 (32%) patients with VT recurrences and 17 (11%) cardiac deaths during follow-up. Patients who fulfilled the combined end point of VT noninducibility and LP abolition compared with inducible patients exhibited a significantly lower incidence of VT recurrence (16.4% versus 47.4%; log-rank P 〈 0.001) and cardiac death (4.1% versus 42.1%; log-rank P 〈 0.001). Among noninducible patients, those with additional LP abolition also had a lower incidence of VT recurrence (16.4% versus 46.0%; log-rank P 〈 0.001). After multivariate analysis, the combined end point of VT noninducibility and LP abolition (hazard ratio, 0.205, P 〈 0.001) was independently associated with VT recurrence and cardiac death (hazard ratio, 0.106; P =0.001). Conclusions— Achieving a combined catheter ablation procedural end point of VT noninducibility and LP abolition reduces VT recurrence rates to low levels (16%). The overall strategy was associated with a significant impact on cardiac survival.
    Type of Medium: Online Resource
    ISSN: 1941-3149 , 1941-3084
    URL: Article
    DOI: 10.1161/CIRCEP.113.001239
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 2425487-3
    Location Call Number Limitation Availability
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    Online Resource
  • 3
    Online Resource
    Online Resource
    Electrical Storm Induced by Cardiac Resynchronization Therapy Is Determined by Pacing on Epicardial Scar and Can be Successfully Managed by Catheter Ablation
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Circulation: Arrhythmia and Electrophysiology Vol. 7, No. 6 ( 2014-12), p. 1064-1069
    Details
    In: Circulation: Arrhythmia and Electrophysiology, Ovid Technologies (Wolters Kluwer Health), Vol. 7, No. 6 ( 2014-12), p. 1064-1069
    Abstract: The mechanism of cardiac resynchronization therapy (CRT)–induced proarrhythmia remains unknown. We postulated that pacing from a left ventricular (LV) lead positioned on epicardial scar can facilitate re-entrant ventricular tachycardia. The aim of this study was to investigate the relationship between CRT-induced proarrhythmia and LV lead location within scar. Methods and Results— Twenty-eight epicardial and 63 endocardial maps, obtained from 64 CRT patients undergoing ventricular tachycardia ablation, were analyzed. A positive LV lead/scar relationship, defined as a lead tip positioned on scar/border zone, was determined by overlaying fluoroscopic projections with LV electroanatomical maps. CRT-induced proarrhythmia occurred in 8 patients (12.5%). They all presented early with electrical storm (100% versus 39% of patients with no proarrhythmia; P 〈 0.01), requiring temporary biventricular pacing discontinuation in half of cases. They more frequently presented with heart failure/cardiogenic shock (50% versus 7%; P 〈 0.01), requiring intensive care management. Ventricular tachycardia was re-entrant in all. The LV lead location within epicardial scar was significantly more frequent in the proarrhythmia group (60% versus 9% P =0.03 on epicardial bipolar scar, 80% versus 17% P =0.02 on epicardial unipolar scar, and 80% versus 17% P =0.02 on any-epicardial scar). Ablation was performed within epicardial scar, close to the LV lead, and allowed CRT reactivation in all patients. Conclusions— CRT-induced proarrhythmia presented early with electrical storm and was associated with an LV lead positioning within epicardial scar. Catheter ablation allowed for resumption of biventricular stimulation in all patients.
    Type of Medium: Online Resource
    ISSN: 1941-3149 , 1941-3084
    URL: Article
    DOI: 10.1161/CIRCEP.114.001796
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 2425487-3
    Location Call Number Limitation Availability
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    Online Resource
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