RESUMEN
BACKGROUND: Catheter ablation (CA) has an established role in scar-related ventricular tachycardia (VT), but the risk of recurrences is substantial and the appropriate intensity of postablation monitoring unknown. The implication of timing of postablation VT recurrence has not been adequately investigated. METHODS: We studied 120 consecutive patients with scar-related VT (age 60 ± 15 years, left ventricular ejection fraction 39 ± 16%, 52% ischemic etiology) with at least 2 years of follow-up. Timing of VT recurrence was classified as very early (<1 month), early (1-6 months), or late (>6 months). RESULTS: At 24 months follow-up, 53 (44%) patients had recurrent VT, with eight (15%) having very early recurrence, 17 (32%) early recurrence, and 28 (53%) late recurrence. Mortality rates at 2 years were significantly higher in patients with very early VT recurrence (38%) compared to those with early (12%), late (7%), and no (3%) recurrences (log-rank P < 0.001). Very early VT recurrence was associated with an increased risk of death (odds ratio = 5.68, 95% confidence interval = 1.06-30.62, P = 0.04), while recurrent VT beyond 6 months was not associated with increased risk of mortality (P = 0.94). CONCLUSIONS: Timing of VT recurrence following CA of scar-related VT impacts subsequent risk of mortality. Patients experiencing VT recurrence within 1-6 months from the procedure are at particularly high risk. These data support the importance of intense postablation monitoring for at least 6 months after the procedure to identify patients with early VT recurrence who may benefit from additional therapeutic interventions to improve outcomes.
Asunto(s)
Ablación por Catéter , Taquicardia Ventricular/mortalidad , Taquicardia Ventricular/cirugía , Anciano , Cicatriz/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Tasa de Supervivencia , Taquicardia Ventricular/etiología , Factores de TiempoRESUMEN
BACKGROUND: The occurrence of periprocedural acute hemodynamic decompensation (AHD) in patients undergoing radiofrequency catheter ablation of scar-related ventricular tachycardia (VT) has not been previously investigated. METHODS AND RESULTS: We identified univariate predictors of periprocedural AHD in 193 consecutive patients undergoing radiofrequency catheter ablation of scar-related VT. AHD was defined as persistent hypotension despite vasopressors and requiring mechanical support or procedure discontinuation. AHD occurred in 22 (11%) patients. Compared with the rest of the population, patients with AHD were older (68.5±10.7 versus 61.6±15.0 years; P=0.037); had a higher prevalence of diabetes mellitus (36% versus 18%; P=0.045), ischemic cardiomyopathy (86% versus 52%; P=0.002), chronic obstructive pulmonary disease (41% versus 13%; P=0.001), and VT storm (77% versus 43%; P=0.002); had more severe heart failure (New York Heart Association class III/IV: 55% versus 15%, P<0.001; left ventricular ejection fraction: 26±10% versus 36±16%, P=0.003); and more often received periprocedural general anesthesia (59% versus 29%; P=0.004). At 21±7 months follow-up, the mortality rate was higher in the AHD group compared with the rest of the population (50% versus 11%, log-rank P<0.001). CONCLUSIONS: AHD occurs in 11% of patients undergoing radiofrequency catheter ablation of scar-related VT and is associated with increased risk of mortality over follow-up. AHD may be predicted by clinical factors, including advanced age, ischemic cardiomyopathy, more severe heart failure status (New York Heart Association class III/IV, lower ejection fraction), associated comorbidities (diabetes mellitus and chronic obstructive pulmonary disease), presentation with VT storm, and use of general anesthesia.
Asunto(s)
Ablación por Catéter/efectos adversos , Cicatriz/complicaciones , Hemodinámica , Hipotensión/etiología , Taquicardia Ventricular/cirugía , Factores de Edad , Anciano , Anestesia General/efectos adversos , Presión Sanguínea , Ablación por Catéter/mortalidad , Cicatriz/diagnóstico , Cicatriz/mortalidad , Comorbilidad , Femenino , Frecuencia Cardíaca , Humanos , Hipotensión/diagnóstico , Hipotensión/mortalidad , Hipotensión/fisiopatología , Hipotensión/terapia , Incidencia , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Medición de Riesgo , Factores de Riesgo , Volumen Sistólico , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/mortalidad , Taquicardia Ventricular/fisiopatología , Factores de Tiempo , Resultado del Tratamiento , Función Ventricular IzquierdaRESUMEN
Two imaging cases highlight the important role of 3D ICE/Cartosound™ in the intracardiac echocardiographic imaging of esophagus and Cartosound™ guidance of radiofrequency lesions delivered safely at the left atrial posterior wall adjacent to esophagus during atrial fibrillation ablation.