Importance of Right Ventricular Mapping and Ablation for Ventricular Tachycardia in Postinfarction Patients.
ischemic cardiomyopathy
radiofrequency ablation
right ventricle
Journal
JACC. Clinical electrophysiology
ISSN: 2405-5018
Titre abrégé: JACC Clin Electrophysiol
Pays: United States
ID NLM: 101656995
Informations de publication
Date de publication:
01 2023
01 2023
Historique:
received:
17
05
2022
revised:
08
08
2022
accepted:
22
08
2022
entrez:
25
1
2023
pubmed:
26
1
2023
medline:
28
1
2023
Statut:
ppublish
Résumé
The characteristics of patients with post-myocardial infarction (PMI) ventricular tachycardia (VT) who require right ventricular (RV) ablation are underreported. The aims of this study were to examine the characteristics and outcomes of patients undergoing PMI VT ablation who have target sites in the right ventricle and to compare patient and VT characteristics between patients with free wall vs septal RV target sites. Consecutive patients undergoing ablation for PMI VT with target sites located within the right ventricle were included. Patients were stratified on the basis of the presence of free wall vs septal RV target sites. Among 277 consecutive patient undergoing PMI VT ablation, 30 (11%) had RV target sites (mean age 68.71 ± 9.5 years, 29 men [97%], mean left ventricular ejection fraction [LVEF] 28.7% ± 16.7%). Twenty patients had only septal VTs, and 10 patients had only free wall VTs. Fifty-seven VTs with RV targets (1.9 ± 1.4 per patient, mean cycle length 338 ± 90 ms, 53 left bundle branch, 36 superior axis) were induced. Patients with RV free wall VTs had greater rates of RV dysfunction (80% vs 30%; P = 0.023) but had greater LVEFs (38.3% ± 21.06% vs 23.9% ± 11.93%; P = 0.02). Over a mean follow-up period of 3.4 ± 3.2 years, patients with RV septal target sites had worse survival free of VT, transplantation, or left ventricular assist device placement after ablation (log-rank P < 0.05). The arrhythmogenic substrate in PMI patients often involves the right ventricle, including the septum and free wall. The presence of RV dysfunction and greater LVEF were associated with the presence of RV free wall target sites. Patients with only RV septal target sites had worse postablation outcomes.
Sections du résumé
BACKGROUND
The characteristics of patients with post-myocardial infarction (PMI) ventricular tachycardia (VT) who require right ventricular (RV) ablation are underreported.
OBJECTIVES
The aims of this study were to examine the characteristics and outcomes of patients undergoing PMI VT ablation who have target sites in the right ventricle and to compare patient and VT characteristics between patients with free wall vs septal RV target sites.
METHODS
Consecutive patients undergoing ablation for PMI VT with target sites located within the right ventricle were included. Patients were stratified on the basis of the presence of free wall vs septal RV target sites.
RESULTS
Among 277 consecutive patient undergoing PMI VT ablation, 30 (11%) had RV target sites (mean age 68.71 ± 9.5 years, 29 men [97%], mean left ventricular ejection fraction [LVEF] 28.7% ± 16.7%). Twenty patients had only septal VTs, and 10 patients had only free wall VTs. Fifty-seven VTs with RV targets (1.9 ± 1.4 per patient, mean cycle length 338 ± 90 ms, 53 left bundle branch, 36 superior axis) were induced. Patients with RV free wall VTs had greater rates of RV dysfunction (80% vs 30%; P = 0.023) but had greater LVEFs (38.3% ± 21.06% vs 23.9% ± 11.93%; P = 0.02). Over a mean follow-up period of 3.4 ± 3.2 years, patients with RV septal target sites had worse survival free of VT, transplantation, or left ventricular assist device placement after ablation (log-rank P < 0.05).
CONCLUSIONS
The arrhythmogenic substrate in PMI patients often involves the right ventricle, including the septum and free wall. The presence of RV dysfunction and greater LVEF were associated with the presence of RV free wall target sites. Patients with only RV septal target sites had worse postablation outcomes.
Identifiants
pubmed: 36697197
pii: S2405-500X(22)00746-0
doi: 10.1016/j.jacep.2022.08.034
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
17-25Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2023 American College of Cardiology Foundation. All rights reserved.
Déclaration de conflit d'intérêts
Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.