Published Online
on June 6, 2008

A more recent version of this article appeared on August 1, 2008

This Article Full Text (PDF) All Versions of this Article: 1/3/153    most recent CIRCEP.108.769471v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Google Scholar Articles by Sacher, F. Articles by Stevenson, W. G. PubMed Articles by Sacher, F. Articles by Stevenson, W. G. Related Collections Ablation/ICD/surgery Arrhythmias, clinical electrophysiology, drugs Related Articles

Original Article

Ventricular Tachycardia Ablation: Evolution of patients and procedures over 8 years

Frédéric Sacher¹, Usha B. Tedrow, Michael Field, Jean-Marc Raymond, Bruce A. Koplan, Laurence M. Epstein and William G. Stevenson

Brigham and Women's Hospital/Harvard Medical School

Correspondence: ¹ E-mail: frederic.sacher{at}chu-bordeaux.fr

Background—Evolving management of coronary artery disease, heart failure, and the use of Implantable Cardioverter-Defibrillators (ICD) impacts the characteristics of patients with recurrent ventricular tachycardia(VT). We investigated the substrate, procedure and outcome evolution of all patients referred for VT ablation over the past 8 years.

Methods and Results—From 1999 to 2006, 493 consecutive patients (358 male, 57±16yo) underwent 623 VT ablations: 131 had no structural heart disease (SHD), 213 ischemic cardiomyopathies (ICMP) and 149 non-ischemic cardiomyopathies (NICMP). Whereas the main substrate is ICMP, the proportion of NICMP has increased from 27% to 35% (p=0.06) from the 1999-2002 to the 2003-2006 period. The procedure abolished or modified inducible VTs in 75% of patients in all groups, but abolition of all monomorphic VTs was achieved in 125 (83%) patients without SHD, 180 (65%) with ICMP and 99 (51%) with NICMP (p<0.0001). During a mean follow-up of 3.3±2.4 years, no deaths occurred in patients without SHD but 75 patients (35%) with ICMP and 26 patients (17%) with NICMP died after a median of 13 months. Multivariate Cox regression analysis found age, ejection fraction and need for preprocedural mechanical hemodynamic support, predicted mortality.

Conclusion—The substrate causing VT in patients requiring ablation is evolving and determines the long term outcome. In the setting of a normal heart, VT ablation is associated with low risk of subsequent mortality with no deaths occurring over a mean follow-up >3years. In contrast, in patients with SHD and recurrent VT, VT ablation can be helpful to suppress drug refractory VT, but long term mortality remains significant.

Key Words: ablation • tachycardia • ventricles

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This article has been cited by other articles:

				F. E. Marchlinski Ventricular Tachycardia Ablation: Moving Beyond Treatment of Last Resort Circ Arrhythmia Electrophysiol, August 1, 2008; 1(3): 147 - 149. [Full Text] [PDF]