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. 2020 Oct;109(10):1282-1291.
doi: 10.1007/s00392-020-01622-z. Epub 2020 Mar 10.

Clinical, procedural and long-term outcome of ischemic VT ablation in patients with previous anterior versus inferior myocardial infarction

Kristina Wasmer  1 , Holger Reinecke  2 , Marius Heitmann  3 , Dirk G Dechering  3 , Florian Reinke  3 , Philipp S Lange  3 , Gerrit Frommeyer  3 , Simon Kochhäuser  3 , Patrick Leitz  3 , Lars Eckardt  3 , Julia Köbe  3
Affiliations

Clinical, procedural and long-term outcome of ischemic VT ablation in patients with previous anterior versus inferior myocardial infarction

Kristina Wasmer et al. Clin Res Cardiol. 2020 Oct.

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: Catheter ablation; Ischemic cardiomyopathy; Localization of scar; Ventricular tachycardia.

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Figures

Fig. 1
Fig. 1
Multivariable Cox regression analyses for total mortality (a) and cardiovascular mortality (b) during follow-up in patients with inferior myocardial infarction (solid black line) and anterior myocardial infarction (dotted red line). Models were adjusted for number of affected coronary vessels, previous bypass surgery, NYHA class, diabetes, amiodarone use, and ejection fraction
Fig. 2
Fig. 2
Kaplan–Meier model of VT-free survival during follow-up in patients with inferior myocardial infarction (solid black line) and anterior myocardial infarction (dotted red line)
See this image and copyright information in PMC

References

    1. Priori SG, Blomström-Lundqvist C, Mazzanti A, et al. ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC) Eur Heart J. 2015;36:2793–2867. doi: 10.1093/eurheartj/ehv316. - DOI - PubMed
    1. Sapp JL, Parkash R, Tang AS. Ventricular tachycardia ablation versus antiarrhythmic-drug escalation. N Engl J Med. 2016;375:1499–1500. doi: 10.1056/NEJMoa1513614. - DOI - PubMed
    1. Tung R, Vaseghi M, Frankel DS, et al. Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: an International VT Ablation Center Collaborative Group study. Heart Rhythm. 2015;12:1997–2007. doi: 10.1016/j.hrthm.2015.05.036. - DOI - PMC - PubMed
    1. Yokokawa M, Kim HM, Baser K, et al. Predictive value of programmed ventricular stimulation after catheter ablation of post-infarction ventricular tachycardia. J Am Coll Cardiol. 2015;65:1954–1959. doi: 10.1016/j.jacc.2015.02.058. - DOI - PubMed
    1. Cronin EM, Bogun FM, Maury P, et al. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Europace. 2019;21(8):1143–1144. doi: 10.1093/europace/euz132. - DOI - PMC - PubMed

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