Results of catheter ablation of malignant ventricular arrhythmias in patients with structural heart disease

    Authors

    Keywords

    ventricular tachycardia, cardiomyopathy, ablation

    DOI

    https://doi.org/10.15836/ccar2018.343

    Full Text

    Introduction: In Croatia, endocardial ablation procedures in patients with structural heart disease (HD) and ventricular arrhythmias (VA) have been successfully implemented since 2012. The method of percutaneous epicardial ablation has been introduced since 2017. ( 1 ) The ablation of VA in electric storm patients is a lifesaving procedure, and in other patients significantly improves the quality of life and reduces the number cardioverter defibrillator (ICD) shocks. Patients and Methods: A retrospective analysis of VA ablations has been made since the beginning of the program in University Hospital Centre Zagreb. All the procedures were performed in electrophysiological (EP) room with local anesthesia, the minority (13.1%) was undergoing general anesthesia. For 3D navigation, the CARTO 3 system was used, and recently multi-polar catheter for high density mapping was used. Substrate and pace mapping was performed, and in some cases activation mapping. Irrigated navigation catheters with maximum 40-50W were used for ablation, and recently contact sensing catheters are available. Ablation success was defined as lack of VA recurrence, and patient follow-up was performed by ICD controls. Results: A total of 38 VA ablations were performed in 36 patients (31 male, age 59.1±12.3 years), of which 55.2% in ischemic HD and 44.7% in nonischemic HD. 3 patients suffered from BBRVT (bundle branch reentrant ventricular tachycardia). The average LVED was 36±11.8% with LVIDd of 63.4±10.5 mm. The average duration of the procedure was 297.1±186.6 min with fluoroscopy of 24.6±18.1 min. At the end of the procedure, 64% of patients were not inducible, and in 10.5% of the patients provocation was not performed after the substrate modification of the. In 2 cases endo/epi ablation was performed, and earlier, 2 patients were sent abroad for epicardial ablation. In 5% of patients there were complications (1 AV fistula and one heart failure worsening). 45.7% of ablation patients had recurrent VA, and in 0.8% follow up is not available. In 11.1% of patients, heart transplantation was performed, and 1 was implanted with LVAD. Conclusion: More successful treatment of heart failure significantly increases the number of patients referred for VA ablation. As these are the most complex EP procedures, ablation outcomes are far from optimal, but the results of our patient series are consistent with the published series in the world.

    Cardiologia Croatica
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    Results of catheter ablation of malignant ventricular arrhythmias in patients with structural heart disease

    Extended Abstract
    Issue11-12
    Published
    Pages343
    PDF via DOIhttps://doi.org/10.15836/ccar2018.343
    ventricular tachycardia
    cardiomyopathy
    ablation

    Authors

    Vedran Velagić*ORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Mia DubravčićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Borka Pezo-NikolićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Mislav PuljevićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Richard MatasićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Miroslav KrpanORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Martina Lovrić-BenčićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Davor PuljevićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Davor MiličićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

    Full Text

    Introduction: In Croatia, endocardial ablation procedures in patients with structural heart disease (HD) and ventricular arrhythmias (VA) have been successfully implemented since 2012. The method of percutaneous epicardial ablation has been introduced since 2017. ( 1 ) The ablation of VA in electric storm patients is a lifesaving procedure, and in other patients significantly improves the quality of life and reduces the number cardioverter defibrillator (ICD) shocks. Patients and Methods: A retrospective analysis of VA ablations has been made since the beginning of the program in University Hospital Centre Zagreb. All the procedures were performed in electrophysiological (EP) room with local anesthesia, the minority (13.1%) was undergoing general anesthesia. For 3D navigation, the CARTO 3 system was used, and recently multi-polar catheter for high density mapping was used. Substrate and pace mapping was performed, and in some cases activation mapping. Irrigated navigation catheters with maximum 40-50W were used for ablation, and recently contact sensing catheters are available. Ablation success was defined as lack of VA recurrence, and patient follow-up was performed by ICD controls. Results: A total of 38 VA ablations were performed in 36 patients (31 male, age 59.1±12.3 years), of which 55.2% in ischemic HD and 44.7% in nonischemic HD. 3 patients suffered from BBRVT (bundle branch reentrant ventricular tachycardia). The average LVED was 36±11.8% with LVIDd of 63.4±10.5 mm. The average duration of the procedure was 297.1±186.6 min with fluoroscopy of 24.6±18.1 min. At the end of the procedure, 64% of patients were not inducible, and in 10.5% of the patients provocation was not performed after the substrate modification of the. In 2 cases endo/epi ablation was performed, and earlier, 2 patients were sent abroad for epicardial ablation. In 5% of patients there were complications (1 AV fistula and one heart failure worsening). 45.7% of ablation patients had recurrent VA, and in 0.8% follow up is not available. In 11.1% of patients, heart transplantation was performed, and 1 was implanted with LVAD. Conclusion: More successful treatment of heart failure significantly increases the number of patients referred for VA ablation. As these are the most complex EP procedures, ablation outcomes are far from optimal, but the results of our patient series are consistent with the published series in the world.