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Radiofrequency catheter ablation of ventricular tachycardia using combined endocardial techniques in patients with structural heart disease improves procedural effectiveness and reduces arrhythmia episodes

Grzegorz Karkowski1, Andrzej Ząbek1, Michał Szotek1, Łukasz Drużbicki2, Jacek Lelakowski1, Jacek Legutko3, Marc Gosnell45, Marcin Kuniewicz14
DOI: 10.33963/KP.a2022.0278
·
Pubmed: 36475512
Affiliations
  1. Department of Electrocardiology, John Paul II Hospital, Kraków, Poland
  2. Department of Pediatric Cardiac Surgery, Institute of Pediatrics, Jagiellonian University Medical College, Poland
  3. Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
  4. Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
  5. Department of Cardiology, Loyola University Medical Center

open access

Online first
Original article
Published online: 2022-12-05

Abstract

Introduction: Radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) in patients with structural heart disease (SHD) is by evidence, safe and effective. However, arrhythmia recurrence is still relatively high and the optimal procedural strategy is unclear. In clinical practice, several combinations of mapping and ablation techniques are used to improve VT ablation efficacy.

Aim: The study aimed to evaluate and provide evidence of the efficiency and safety of a systematized combination of VT ablation (mapping) techniques in patients with SHD.

Methods: From 2016 to 2019, 47 patients (54 procedures) with SHD (89% heart failure, 94% ischemic heart disease, 37% VT storm) who underwent RFCA of VT were retrospectively analyzed from a group of 58 consecutive patients. During RFCA of VT, different combinations of three techniques, (activation mapping (AM), pace-mapping (PM), and substrate-based mapping (SbM), were used. The procedures were performed using the CARTO® 3 (Biosense Webster Inc., Diamond Bar, CA, US) electro-anatomical mapping system.

Results: During a median (interquartile range [IQR]) follow-up of 25.5 months (11.75‒52.25), VT-free survival after ablation was 68.5% (n = 37/54 procedures). Acute procedural success was achieved in 85% (n = 46/54 procedures). The number of induced VT morphologies, induction of non-clinical or unsustained VT after ablation and less VT mapping techniques used during procedure were related to decreasing VT free-survival.

Conclusions: VT ablation strategy based on combined systematized techniques is effective and safe in long-term follow-up patients with SHD.

Abstract

Introduction: Radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) in patients with structural heart disease (SHD) is by evidence, safe and effective. However, arrhythmia recurrence is still relatively high and the optimal procedural strategy is unclear. In clinical practice, several combinations of mapping and ablation techniques are used to improve VT ablation efficacy.

Aim: The study aimed to evaluate and provide evidence of the efficiency and safety of a systematized combination of VT ablation (mapping) techniques in patients with SHD.

Methods: From 2016 to 2019, 47 patients (54 procedures) with SHD (89% heart failure, 94% ischemic heart disease, 37% VT storm) who underwent RFCA of VT were retrospectively analyzed from a group of 58 consecutive patients. During RFCA of VT, different combinations of three techniques, (activation mapping (AM), pace-mapping (PM), and substrate-based mapping (SbM), were used. The procedures were performed using the CARTO® 3 (Biosense Webster Inc., Diamond Bar, CA, US) electro-anatomical mapping system.

Results: During a median (interquartile range [IQR]) follow-up of 25.5 months (11.75‒52.25), VT-free survival after ablation was 68.5% (n = 37/54 procedures). Acute procedural success was achieved in 85% (n = 46/54 procedures). The number of induced VT morphologies, induction of non-clinical or unsustained VT after ablation and less VT mapping techniques used during procedure were related to decreasing VT free-survival.

Conclusions: VT ablation strategy based on combined systematized techniques is effective and safe in long-term follow-up patients with SHD.

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Keywords

catheter ablation, heart failure, pace-mapping, ventricular tachycardia

About this article
Title

Radiofrequency catheter ablation of ventricular tachycardia using combined endocardial techniques in patients with structural heart disease improves procedural effectiveness and reduces arrhythmia episodes

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2022-12-05

Page views

78

Article views/downloads

36

DOI

10.33963/KP.a2022.0278

Pubmed

36475512

Keywords

catheter ablation
heart failure
pace-mapping
ventricular tachycardia

Authors

Grzegorz Karkowski
Andrzej Ząbek
Michał Szotek
Łukasz Drużbicki
Jacek Lelakowski
Jacek Legutko
Marc Gosnell
Marcin Kuniewicz

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