In This Issue: January.

Abstract

Paul J. Wang, MD Click here to go to the podcast Click here to go to the article. Ratika Parkash, MD, MS… John Sapp, MD Ratika Parkash and associates examined whether the outcomes after escalated antiarrhythmic drug therapy or catheter ablation depended on whether ventricular tachycardia was amiodarone-refractory or sotalol-refractory in patients with prior myocardial infarction in the VANISH study (Ventricular Tachycardia Ablation Versus Escalated Antiarrhythmic Drug Therapy in Ischemic Heart Disease). At baseline, 169 (65.2%) were amiodarone-refractory and 90 (34.7%) were sotalol-refractory; 1 patient was on procainamide rather than sotalol. Patients with amiodarone-refractory had more renal insufficiency (23.7% versus 10%; P =0.0008), worse New York Heart Association class (82.3% II/III versus 65.5%; P =0.0003), and lower ejection fraction (29±9.7% versus 35.2±11%; P <0.0001). Within the amiodarone-refractory group, ablation resulted in reduction of any ventricular arrhythmia compared with escalated drug therapy (hazard ratio, 0.53; 95% confidence interval, 0.31–0.9; P =0.020). Patients with sotalol-refractory had trends toward higher mortality and ventricular tachycardia storm with ablation, with no effect on implantable cardioverter defibrillator shocks. Within the escalated drug therapy arm, patients with amiodarone-refractory had a higher rate of the composite outcome (hazard ratio, 1.94; 95% confidence interval, 1.14–3.29; P =0.0144), and a trend to higher mortality (hazard ratio, 2.40; 95% confidence interval, 0.93–6.22; P =0.07), whereas mortality was not different between patients with amiodarone and sotalol-refractory within the ablation treatment group. Click here to go to the article. Junaid A.B. Zaman, MA, BMBCh, MRCP… Nicholas S. Peters, MD Junaid A.B. Zaman and associates examined 57 cases in which local ablation of persistent atrial fibrillation terminated to sinus rhythm or organized tachycardia. The authors analyzed unipolar electrograms collected during atrial fibrillation from multipolar basket catheters to construct isochronal activation maps for multiple cycles and computational modeling and phase analysis were used to study mechanisms of map variability. At all sites of atrial fibrillation termination, localized repetitive activation patterns were observed: 21% with complete rotational …