705-6 Post-Infarct Ventricular Tachycardia: Success Rate of Catheter Ablation

• Published in: Journal of the American College of Cardiology 1995-02, Vol.25 (2), p.42A-42A
• Main Authors: Rothman, Steven A., Hsia, Henry H., Cossú, Sergio F., Thome, Lisa M., Adelizzi, Nancy M., Whitley, Deborah M., Buxton, Alfred E., Miller, John M.
• Format: Article
• Language: English
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(95)91631-7

Reports of catheter ablation (CA) of infarct-based ventricular tachycardia (VT) have generally targeted slow VTs of 1 morphology; success rates have been variable. We performed radiofrequency CA in 25 patients (pts) who presented with sustained uniform VT, with the intent of eliminating allinducible uniform-morphology VTs (not just “clinical” VTs). CA was performed during 94 distinct VTs; 65 of these (69%) could not be induced thereafter. In individual pts, success of CA was defined as complete (absence of any inducible uniform VT) or partial (elimination of some but not all VTs). Results among the 25 pts: Successn#VTs/PtProcedure Time (min)RecurrenceComplete17(68%)3.0 ± 2.0*320 ± 1680(10%)Partial5(20%)6.4 ± 4.0*306 ± 1755(100%)Failure3(12%)3.7 ± 2.9243 ± 1191(33%)P value0.03*NS0.001 Of the 17 pts with complete success, 10 received no other treatment, 5 had an implantable defibrillator and 2 pts remained on prior antiarrhythmic drugs. No clinical recurrences or implantable defibrillator discharges occurred in any of these pts after a mean follow-up of 6 ±4 months. Follow-up stimulation 3 months later showed no inducible VT in 8/10 pts (80%) discharged without inducible VT. Of the 5 pts with partial success, 3 have had a marked decrease in frequency of VT recurrences. None of the documented recurrences was fatal. One pt with frequent episodes of stable VT for years had possible sudden death 2 months post CA (without symptoms in interim). The mean cycle length of successfully ablated VTs was 366±74ms vs 312 ± 51ms for unsuccessfully ablated VTs (p < 0.01). 1) Immediate and long term success can be achieved with aggressive radiofrequency CA in a majority of patients with sustained monomorphic VT post-infarct, even when multiple VT morphologies are present. 2) VTs with cycle length <400ms can be successfully ablated but faster VTs are less easily ablated, not entirely related to hemodynamic tolerance.