Clinical, procedural and long-term outcome of ischemic VT ablation in patients with previous anterior versus inferior myocardial infarction
Open Access
- 10 March 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Clinical Research in Cardiology
- Vol. 109 (10), 1282-1291
- https://doi.org/10.1007/s00392-020-01622-z
Abstract
Background Outcome of ischemic VT ablation may differ between patients with previous myocardial infarction (MI) in relation to infarct localization. Methods We analyzed procedural data, acute and long-term outcomes of 152 consecutive patients (139 men, mean age 67 ± 9 years) with previous anterior or inferior MI who underwent ischemic VT ablation at our institution between January 2010 and October 2015. Results More patients had a history of inferior MI (58%). Mean ejection fraction was significantly lower in anterior MI patients (28 ± 10% vs. 34 ± 10%, p < 0.001). NYHA class and presence of comorbidities were not different between the groups. Indication for the procedure was electrical storm in 43% of patients, and frequent implantable cardioverter defibrillator (ICD) therapies in 57%, and did not differ significantly between anterior and inferior MI patients. A mean of 3 ± 2 VT morphologies were inducible, with a trend towards more VT in the anterior MI group (3.1 ± 2.2 vs. 2.6 ± 1.9, p = 0.18). Procedural parameters and acute success did not differ between the groups. During a mean follow-up of 3 ± 2 years, more anterior MI patients had undergone a re-ablation (49% vs. 33%, p = 0.09, Chi-square test). There was a trend towards more ICD shocks in patients with previous anterior MI (46% vs. 34%). After adjusting for risk factors and ejection fraction, multivariable Cox regression analyses showed no significant difference in mortality (p = 0.78) and cardiovascular mortality between infarct localizations (p = 0.6). Conclusion Clinical characteristics of patients with anterior and inferior MI are similar except for ejection fraction. Patients with inferior MI appear to have better outcome regarding survival, ICD shocks and re-ablation, but this appears to be related to better ejection fraction when compared with anterior MI.Keywords
This publication has 36 references indexed in Scilit:
- Distribution of late potentials within infarct scars assessed by ultra high-density mappingHeart Rhythm, 2010
- Ventricular arrhythmia in coronary artery disease: limits of a risk stratification strategy based on the ejection fraction alone and impact of infarct localizationEP Europace, 2009
- EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: Developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA)Heart Rhythm, 2009
- EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: Developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA)EP Europace, 2009
- Irrigated Radiofrequency Catheter Ablation Guided by Electroanatomic Mapping for Recurrent Ventricular Tachycardia After Myocardial InfarctionCirculation, 2008
- Ventricular Tachycardia AblationCirculation: Arrhythmia and Electrophysiology, 2008
- Value of high-density endocardial and epicardial mapping for catheter ablation of hemodynamically unstable ventricular tachycardiaHeart Rhythm, 2006
- Nonsurgical transthoracic epicardial radiofrequency ablation: An alternative in incessant ventricular tachycardiaJournal of the American College of Cardiology, 2003
- Quality of life in the Canadian Implantable Defibrillator Study (CIDS)American Heart Journal, 2002
- Electroanatomic Left Ventricular Mapping in the Porcine Model of Healed Anterior Myocardial InfarctionCirculation, 1999