Safety, Long-Term Results, and Predictors of Recurrence After Complete Endocardial Ventricular Tachycardia Substrate Ablation in Patients With Previous Myocardial Infarction

• Published in: The American journal of cardiology 2013-02, Vol.111 (4), p.499-505
• Main Authors: Arenal, Ángel, MD, Hernández, Jesús, MD, Calvo, David, MD, Ceballos, Cecilia, Atéa, Leonardo, MD, Datino, Tomás, MD, PhD, Atienza, Felipe, MD, PhD, González-Torrecilla, Esteban, MD, PhD, Eídelman, Gabriél, MD, Miracle, Ángel, MD, Avila, Pablo, MD, Bermejo, Javier, MD, PhD, Fernández-Avilés, Francisco, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Body Surface Potential Mapping - methods; Cardiac arrhythmia; Cardiovascular; Catheter Ablation - methods; Endocardium - physiopathology; Endocardium - surgery; Female; Follow-Up Studies; Heart attacks; Heart Rate - physiology; Humans; Male; Mortality; Myocardial Infarction - complications; Patients; Prognosis; Prospective Studies; Recurrence; Sinuses; Tachycardia, Ventricular - etiology; Tachycardia, Ventricular - physiopathology; Tachycardia, Ventricular - surgery; Time Factors; Treatment Outcome
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2012.10.031

Conduction channels and electrograms with isolated component/late potentials are sensitive markers of the substrate of post–myocardial infarction sustained monomorphic ventricular tachycardia (VT). Ablation of all conduction channels and isolated component/late potentials (complete endocardial VT substrate ablation [CEVTSA]) during sinus rhythm could simplify and facilitate the ablation procedure, mainly in patients without references for clinical VT substrate identification. The aim of this study was to assess the safety, efficacy, and predictors of VT recurrence after CEVTSA. Electroanatomic mapping and CEVTSA were performed in 59 post–myocardial infarction patients (mean age 67 ± 9 years, mean left ventricular ejection fraction 30 ± 11%), 24 of whom did not have clinical VT substrate references. The mean areas of scar (≤1.5 mV) and dense scar (≤0.5 mV) were 76 ± 42 and 34 ± 24 cm2 , respectively; isolated component/late potentials and conduction channels were identified and ablated in 97% and 83% of patients (mean ablation area 14 ± 10 cm2 ). No life-threatening complications occurred during the procedure. After 1 year and at the end of follow-up (mean 39 ± 21 months), 81% and 58% of patients were free of VT. No differences were observed between patients with and without specific clinical VT substrate identification. Univariate analysis identified the left ventricular ejection fraction, VT cycle length (VTCL), infarct location (inferior vs anterior), and dense scar area as predictors of VT recurrence, and Cox analysis identified VTCL (hazard ratio 0.42, p