Radiofrequency catheter ablation of postinfarction ventricular tachycardia : Long-term success and the significance of inducible nonclinical arrhythmias

Radiofrequency (RF) catheter ablation is effective therapy for monomorphic ventricular tachycardia (VT) in patients without structural heart disease. In patients with postinfarction VT; however, this procedure has been used predominantly as adjunctive therapy, targeting only the patient's clini...

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Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 1997-11, Vol.96 (10), p.3499-3508
Main Authors: ROTHMAN, S. A, HSIA, H. H, COSSU, S. F, CHMIELEWSKI, I. L, BUXTON, A. E, MILLER, J. M
Format: Article
Language:English
Subjects:
Aged
Arrhythmias, Cardiac - physiopathology
Biological and medical sciences
Cardiology. Vascular system
Catheter Ablation - adverse effects
Coronary heart disease
Electrophysiology
Heart
Humans
Medical sciences
Middle Aged
Myocardial Infarction - complications
Recurrence
Tachycardia, Ventricular - etiology
Tachycardia, Ventricular - surgery
Time Factors
Treatment Failure
Treatment Outcome
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Summary:Radiofrequency (RF) catheter ablation is effective therapy for monomorphic ventricular tachycardia (VT) in patients without structural heart disease. In patients with postinfarction VT; however, this procedure has been used predominantly as adjunctive therapy, targeting only the patient's clinically documented arrhythmia. By targeting all inducible, sustained VT morphologies, we sought to determine the utility of RF catheter ablation as a primary cure in patients who present with hemodynamically tolerated VT. RF ablation was attempted in 35 patients with a previous myocardial infarction and recurrent, hemodynamically tolerated VT. A mean of 3.9+/-2.7 VTs were induced per patient (range, 1 to 10). The clinically documented arrhythmia was successfully ablated in 30 of 35 patients (86%), and on follow-up electrophysiological testing, 11 patients had no inducible VT and were discharged without other therapy. Nineteen patients had inducible "nonclinical" arrhythmias on follow-up testing, and the majority underwent cardiac defibrillator implantation. Freedom from recurrent arrhythmias, including sudden death, was 91% in patients without inducible VT and 53% in patients with persistently inducible "nonclinical" arrhythmias (P
ISSN:0009-7322
1524-4539
DOI:10.1161/01.CIR.96.10.3499