Radiofrequency catheter ablation of postinfarction ventricular tachycardia: Long-term success and the significance of inducible nonclinical arrhythmias

Steven A. Rothman, Henry H. Hsia, Sergio F. Cossú, I. Lisa Chmielewski, Alfred E. Buxton, John M. Miller

Research output: Contribution to journalArticle

144 Citations (Scopus)

Abstract

Background: Radiofrequency (RF) catheter ablation is effective therapy for monomorphic ventricular tachycardia (VT) in patients without structural heart disease. In patients with postinfarction VT; however, this procedure has been used predominantly as adjunctive therapy, targeting only the patient's clinically documented arrhythmia. By targeting all inducible, sustained VT morphologies, we sought to determine the utility of RF catheter ablation as a primary cure in patients who present with hemodynamically tolerated VT. Methods and Results: RF ablation was attempted in 35 patients with a previous myocardial infarction and recurrent, hemodynamically tolerated VT. A mean of 3.9±2.7 VTs were induced per patient (range, 1 to 10). The clinically documented arrhythmia was successfully ablated in 30 of 35 patients (86%), and on follow-up electrophysiological testing, 11 patients had no inducible VT and were discharged without other therapy. Nineteen patients had inducible 'nonclinical' arrhythmias on follow-up testing, and the majority underwent cardiac defibrillator implantation. Freedom from recurrent arrhythmias, including sudden death, was 91% in patients without inducible VT and 53% in patients with persistently inducible 'nonclinical' arrhythmias (P<.05; mean follow-up, 17±12 and 12±11 months, respectively). Conclusions: In patients with well-tolerated VT, RF catheter ablation may be useful as a primary cure if no other ventricular arrhythmias are inducible on follow-up testing. Ablation of all hemodynamically tolerated arrhythmias should be attempted in patients with multiple inducible VT morphologies because of the high rate of recurrence of unablated VTs in these patients.

Original languageEnglish (US)
Pages (from-to)3499-3508
Number of pages10
JournalCirculation
Volume96
Issue number10
DOIs
StatePublished - Nov 18 1997

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Catheter Ablation
Ventricular Tachycardia
Cardiac Arrhythmias
Defibrillators
Sudden Death
Heart Diseases
Therapeutics
Myocardial Infarction

Keywords

  • Catheter ablation
  • Coronary disease
  • Tachyarrhythmias
  • Tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Radiofrequency catheter ablation of postinfarction ventricular tachycardia : Long-term success and the significance of inducible nonclinical arrhythmias. / Rothman, Steven A.; Hsia, Henry H.; Cossú, Sergio F.; Chmielewski, I. Lisa; Buxton, Alfred E.; Miller, John M.

In: Circulation, Vol. 96, No. 10, 18.11.1997, p. 3499-3508.

Research output: Contribution to journalArticle

Rothman, Steven A. ; Hsia, Henry H. ; Cossú, Sergio F. ; Chmielewski, I. Lisa ; Buxton, Alfred E. ; Miller, John M. / Radiofrequency catheter ablation of postinfarction ventricular tachycardia : Long-term success and the significance of inducible nonclinical arrhythmias. In: Circulation. 1997 ; Vol. 96, No. 10. pp. 3499-3508.
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abstract = "Background: Radiofrequency (RF) catheter ablation is effective therapy for monomorphic ventricular tachycardia (VT) in patients without structural heart disease. In patients with postinfarction VT; however, this procedure has been used predominantly as adjunctive therapy, targeting only the patient's clinically documented arrhythmia. By targeting all inducible, sustained VT morphologies, we sought to determine the utility of RF catheter ablation as a primary cure in patients who present with hemodynamically tolerated VT. Methods and Results: RF ablation was attempted in 35 patients with a previous myocardial infarction and recurrent, hemodynamically tolerated VT. A mean of 3.9±2.7 VTs were induced per patient (range, 1 to 10). The clinically documented arrhythmia was successfully ablated in 30 of 35 patients (86{\%}), and on follow-up electrophysiological testing, 11 patients had no inducible VT and were discharged without other therapy. Nineteen patients had inducible 'nonclinical' arrhythmias on follow-up testing, and the majority underwent cardiac defibrillator implantation. Freedom from recurrent arrhythmias, including sudden death, was 91{\%} in patients without inducible VT and 53{\%} in patients with persistently inducible 'nonclinical' arrhythmias (P<.05; mean follow-up, 17±12 and 12±11 months, respectively). Conclusions: In patients with well-tolerated VT, RF catheter ablation may be useful as a primary cure if no other ventricular arrhythmias are inducible on follow-up testing. Ablation of all hemodynamically tolerated arrhythmias should be attempted in patients with multiple inducible VT morphologies because of the high rate of recurrence of unablated VTs in these patients.",
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AU - Rothman, Steven A.

AU - Hsia, Henry H.

AU - Cossú, Sergio F.

AU - Chmielewski, I. Lisa

AU - Buxton, Alfred E.

AU - Miller, John M.

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N2 - Background: Radiofrequency (RF) catheter ablation is effective therapy for monomorphic ventricular tachycardia (VT) in patients without structural heart disease. In patients with postinfarction VT; however, this procedure has been used predominantly as adjunctive therapy, targeting only the patient's clinically documented arrhythmia. By targeting all inducible, sustained VT morphologies, we sought to determine the utility of RF catheter ablation as a primary cure in patients who present with hemodynamically tolerated VT. Methods and Results: RF ablation was attempted in 35 patients with a previous myocardial infarction and recurrent, hemodynamically tolerated VT. A mean of 3.9±2.7 VTs were induced per patient (range, 1 to 10). The clinically documented arrhythmia was successfully ablated in 30 of 35 patients (86%), and on follow-up electrophysiological testing, 11 patients had no inducible VT and were discharged without other therapy. Nineteen patients had inducible 'nonclinical' arrhythmias on follow-up testing, and the majority underwent cardiac defibrillator implantation. Freedom from recurrent arrhythmias, including sudden death, was 91% in patients without inducible VT and 53% in patients with persistently inducible 'nonclinical' arrhythmias (P<.05; mean follow-up, 17±12 and 12±11 months, respectively). Conclusions: In patients with well-tolerated VT, RF catheter ablation may be useful as a primary cure if no other ventricular arrhythmias are inducible on follow-up testing. Ablation of all hemodynamically tolerated arrhythmias should be attempted in patients with multiple inducible VT morphologies because of the high rate of recurrence of unablated VTs in these patients.

AB - Background: Radiofrequency (RF) catheter ablation is effective therapy for monomorphic ventricular tachycardia (VT) in patients without structural heart disease. In patients with postinfarction VT; however, this procedure has been used predominantly as adjunctive therapy, targeting only the patient's clinically documented arrhythmia. By targeting all inducible, sustained VT morphologies, we sought to determine the utility of RF catheter ablation as a primary cure in patients who present with hemodynamically tolerated VT. Methods and Results: RF ablation was attempted in 35 patients with a previous myocardial infarction and recurrent, hemodynamically tolerated VT. A mean of 3.9±2.7 VTs were induced per patient (range, 1 to 10). The clinically documented arrhythmia was successfully ablated in 30 of 35 patients (86%), and on follow-up electrophysiological testing, 11 patients had no inducible VT and were discharged without other therapy. Nineteen patients had inducible 'nonclinical' arrhythmias on follow-up testing, and the majority underwent cardiac defibrillator implantation. Freedom from recurrent arrhythmias, including sudden death, was 91% in patients without inducible VT and 53% in patients with persistently inducible 'nonclinical' arrhythmias (P<.05; mean follow-up, 17±12 and 12±11 months, respectively). Conclusions: In patients with well-tolerated VT, RF catheter ablation may be useful as a primary cure if no other ventricular arrhythmias are inducible on follow-up testing. Ablation of all hemodynamically tolerated arrhythmias should be attempted in patients with multiple inducible VT morphologies because of the high rate of recurrence of unablated VTs in these patients.

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KW - Coronary disease

KW - Tachyarrhythmias

KW - Tachycardia

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