P5692Catheter ablation of ventricular tachyarrhythmias in ischemic patients may contribute to better survival: a new clinical challenge

Abstract

Abstract Background Ventricular arrhythmias contribute to significant escalation of mortality rate in patients with ischemic cardiomyopathy (ICM). Risk of sudden cardiac death (SCD) could be reduced after implantation of a cardioverter-defibrillator (ICD), yet at the same time more frequent shock episodes are associated with poor life quality and higher hospitalization rate. Radiofrequency (RF) ablation of triggering ventricular premature beats or substrate-based catheter treatment are considered to be effective in patients with ICM but prognosis remains controversial. Objective To evaluate role of catheter treatment of ventricular tachyarrhythmias (VTA) and its effect on survival in patients with ischemic cardiomyopathy. Methods We enrolled 72 consecutive patients (mean age 64±13 years, 63 male) with prior myocardial infarction (more than 40 days ago) and documented ventricular tachycardia (VT) episodes, including 12 patients which underwent emergency electrical storm ablation. Considering number of VT recurrence episodes after catheter treatment all patients were divided into two groups. First group consisted of 27 patients (37%) with recurrent sustained VT (mean age 62±10 years) while second group included 45 patients (63%) without VT recurrence (mean age 63±12 years). During follow up most of VT episodes were registered in 13±9 years after acute myocardial infarction. Catheter treatment included mapping during hemodynamically tolerated clinically relevant VT and then ablation of VT triggers with subsequent homogenization of the scar. Patients with “fast” VT underwent primary scar homogenization. Results Effectiveness of clinically relevant VT ablation in patients with ICM was 63%. During follow-up period all patients were alive and remained relatively stable. Long-term effectiveness of ES elimination was 100% while freedom from clinically significant VTA was up to 79% due to repeated ablation procedures. We also observed improvement of NYHA functional class in 80% of patients. Conclusion Catheter ablation of VTA may be effective treatment both in acute period and long term follow up. It also may be effective in improvement of heart failure NYHA functional class in some patients and contributes to better survival in patients with ICM.