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Stepwise Approach for Ventricular Tachycardia Ablation in Patients With Predominantly Intramural Scar
- Source :
- JACC: Clinical Electrophysiology
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- Objectives The goal of this study was to assess the value of a stepwise, image-guided ablation approach in patients with cardiomyopathy and predominantly intramural scar. Background Few reports have focused on catheter-based ventricular tachycardia (VT) ablation strategies in patients with predominantly intramural scar. Methods The study included patients with predominantly intramural scar undergoing VT ablation. A stepwise strategy was performed consisting of a localized ablation guided by conventional mapping criteria followed by a more extensive ablation if VT remained inducible. The extensive ablation was guided by the location and extent of intramural scarring on delayed enhanced–cardiac magnetic resonance imaging. A historical cohort who did not undergo additional extensive ablation was identified for comparison. A novel measurement, the scar depth index (SDI), indicating the percent area of the scar at a given depth, was correlated with outcomes. Results Forty-two patients who underwent stepwise ablation (median age 61 years [interquartile range: 55 to 69 years], 35 male patients, median left ventricular ejection fraction 36.0% [25.0% to 55.0%], ischemic [n = 4] or nonischemic cardiomyopathy [n = 38]) were followed up for a median of 17 months (8 to 36 months). A stepwise approach resulted in a 1-year freedom from VT, death, or cardiac transplantation of 76% (32 of 42). Patients who underwent additional extensive ablation had a lower risk of events than a clinically similar historical cohort (N = 19) (hazard ratio: 0.30; 95% CI: 0.13 to 0.68; p 5mm was associated with worse long-term outcomes (hazard ratio: 1.03; 95% CI: 1.01 to 1.06%; p = 0.03), SDI>5mm >16.5% was associated with failed ablation (area under the curve: 0.84; 95% CI: 0.71 to 0.97). Conclusions Stepwise ablation using delayed enhanced–cardiac magnetic resonance guidance is a novel approach to VT ablation in patients with predominantly intramural scarring. The SDI correlates with immediate procedural and long-term outcomes.
- Subjects :
- Male
medicine.medical_specialty
Radiofrequency ablation
medicine.medical_treatment
Cardiomyopathy
Catheter ablation
030204 cardiovascular system & hematology
Ventricular tachycardia
Ventricular Function, Left
law.invention
Cicatrix
03 medical and health sciences
0302 clinical medicine
law
Interquartile range
Internal medicine
medicine
Humans
030212 general & internal medicine
Ejection fraction
business.industry
Stroke Volume
Middle Aged
medicine.disease
Ablation
Transplantation
Catheter Ablation
Tachycardia, Ventricular
Cardiology
Electrophysiologic Techniques, Cardiac
business
Subjects
Details
- ISSN :
- 2405500X
- Volume :
- 6
- Database :
- OpenAIRE
- Journal :
- JACC: Clinical Electrophysiology
- Accession number :
- edsair.doi.dedup.....ab3882f9a1ae22115be2465990c1427c