Radiofrequency Catheter Ablation of Ventricular Tachycardia in Patients With Hypertrophic Cardiomyopathy and Apical Aneurysm

Abstract

Objectives: This study evaluated the characteristics and results of radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) in patients with hypertrophic cardiomyopathy (HCM) and left ventricular apical aneurysm (AA).

Background: Monomorphic VT in patients with HCM and left ventricular AA has been reported. However, outcome data of RFCA are insufficient.

Methods: Fifteen patients with HCM and AA who underwent RFCA for VT at 5 different institutions were included in this study. The data were evaluated retrospectively.

Results: Endocardial voltage mapping showed a low-voltage area (LVA), and late potential in the AA was recorded in 12 patients (80%). Although epicardial or intramural origin of VT was suspected in 7 patients, endocardial RFCA successfully suppressed the VT at the LVA border (n = 10) or within the LVA (n = 2). In 2 of 3 patients without LVA at the endocardial site, linear RFCA at the anterior wall of the aneurysmal neck side was successful. In the remaining patient, endocardial RFCA of AA was not effective, and epicardial RFCA site was needed. In all patients, clinical VT became noninducible after RFCA. VT recurrence was observed in 2 patients (13.3%) during the 12-month follow-up period. One patient underwent a second endocardial RFCA, and no VT recurrence was noted. In the other patient, VT recurred 3 months after RFCA and was successfully terminated by antitachycardia pacing of the implantable cardioverter-defibrillator.

Conclusions: In patients with HCM and AA, endocardial RFCA of AA effectively suppressed monomorphic VT which was related to AA and resulted in satisfactory outcomes.

Keywords: apical aneurysm; hypertrophic cardiomyopathy; outcome radiofrequency catheter ablation; ventricular tachycardia.