Ablation of ventricular tachycardia in patients with structural heart disease – single centre experience

    Authors

    Keywords

    ventricular tachycardia, ablation, sudden cardiac death

    DOI

    https://doi.org/10.15836/ccar2016.429

    Full Text

    **Background:** Ablation of ventricular tachycardia (VT) in structural heart disease (SHD) is an effective tool to prevent VT reccurence, improve quality of life and reduce therapy with implantable cardioverter defibrillator (ICD). (1) **Patients and Methods:** Patients treated for sustained VT who underwent radiofrequency ablation from December 2014 until September 2016 in University Hospital Centre ‘’Sestre milosrdnice’’ were included. Electrophysiology studies were performed according to local protocols. Acute success rates, complications and hospital outcomes were evaluated. Also, clinical data and implantable cardioverter defibrilator data were evaluated during the follow up. **Results:** Total of 36 patients were reffered for ablation of sustained VT. Among those, 8 (22%) had no overt SHD while 28 (78%) had SHD. 16 patients (57%) had ishemic heart disease (IHD) while 12 (43%) had non ischemic heart disease (NIHD). 2 patients with IHD (12.5%) had stable VTs that were mapped and ablated while 14 (87.5%) had unstable VTs and substrate modification was performed. In patients with IHD all patients had non inducible clinical VT or any VT at the end of the procedure. There were no procedure related complications. There was one in hospital death (6.2%) due to severe, prolonged cardiogenic shock four days post ablation. After median follow up of 7 months (4-14) there was one re-do procedure. In patients with NIHD 4 (33%) had bundle branch reentry VT, 2 had focal VTs originating from papillary muscle and aortic cusp. 2 patients had VT that was ablated at lateral mitral annulus. 4 (33%) patients had either polymorphic VT or unstable VTs that could not be mapped with no identifiable substrate endocardially. **Conclusion:** Results and experience are comparable to those reported in larger studies. Ablation of sustained VT in patients with SHD is a useful tool to prevent VT reccurence and reduce ICD therapies. However, it should be performed in high-volume centers with standardized protocols for ablation, monitoring and care.

    Literature

    1. Sapp JL, Wells GA, Parkash R, Stevenson WG, Blier L, Sarrazin JF, et al. Ventricular Tachycardia Ablation versus Escalation of Antiarrhythmic Drugs. N Engl J Med. 2016;375(2):111–21. https://doi.org/10.1056/NEJMoa1513614
    Cardiologia Croatica
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    Ablation of ventricular tachycardia in patients with structural heart disease – single centre experience

    Extended Abstract
    Issue10-11
    Published
    Pages429
    PDF via DOIhttps://doi.org/10.15836/ccar2016.429
    ventricular tachycardia
    ablation
    sudden cardiac death

    Authors

    Nikola Pavlović*ORCIDUniversity Hospital Center “Sestre milosrdnice”, Zagreb, Croatia
    Vjekoslav RadeljićORCIDUniversity Hospital Center “Sestre milosrdnice”, Zagreb, Croatia
    Ivan ZeljkovićORCIDUniversity Hospital Center “Sestre milosrdnice”, Zagreb, Croatia
    Ivica BenkoORCIDUniversity Hospital Center “Sestre milosrdnice”, Zagreb, Croatia
    Šime ManolaORCIDUniversity Hospital Center “Sestre milosrdnice”, Zagreb, Croatia

    *Correspondence email: nikolap12@yahoo.com

    Full Text

    Background: Ablation of ventricular tachycardia (VT) in structural heart disease (SHD) is an effective tool to prevent VT reccurence, improve quality of life and reduce therapy with implantable cardioverter defibrillator (ICD). (1)

    Patients and Methods: Patients treated for sustained VT who underwent radiofrequency ablation from December 2014 until September 2016 in University Hospital Centre ‘’Sestre milosrdnice’’ were included. Electrophysiology studies were performed according to local protocols. Acute success rates, complications and hospital outcomes were evaluated. Also, clinical data and implantable cardioverter defibrilator data were evaluated during the follow up.

    Results: Total of 36 patients were reffered for ablation of sustained VT. Among those, 8 (22%) had no overt SHD while 28 (78%) had SHD. 16 patients (57%) had ishemic heart disease (IHD) while 12 (43%) had non ischemic heart disease (NIHD). 2 patients with IHD (12.5%) had stable VTs that were mapped and ablated while 14 (87.5%) had unstable VTs and substrate modification was performed. In patients with IHD all patients had non inducible clinical VT or any VT at the end of the procedure. There were no procedure related complications. There was one in hospital death (6.2%) due to severe, prolonged cardiogenic shock four days post ablation. After median follow up of 7 months (4–14) there was one re-do procedure. In patients with NIHD 4 (33%) had bundle branch reentry VT, 2 had focal VTs originating from papillary muscle and aortic cusp. 2 patients had VT that was ablated at lateral mitral annulus. 4 (33%) patients had either polymorphic VT or unstable VTs that could not be mapped with no identifiable substrate endocardially.

    Conclusion: Results and experience are comparable to those reported in larger studies. Ablation of sustained VT in patients with SHD is a useful tool to prevent VT reccurence and reduce ICD therapies. However, it should be performed in high-volume centers with standardized protocols for ablation, monitoring and care.

    Literature

    1. 1.
      Sapp JL, Wells GA, Parkash R, Stevenson WG, Blier L, Sarrazin JF, et al. Ventricular Tachycardia Ablation versus Escalation of Antiarrhythmic Drugs. N Engl J Med. 2016;375(2):111–21.DOI