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Outcome of catheter ablation of non-reentrant ventricular arrhythmias in patients with and without structural heart disease.

ABSTRACT: BACKGROUND:Catheter ablation of non-reentrant, commonly termed "idiopathic" ventricular arrhythmias (VA) is highly effective in patients without structural heart disease (SHD). Meanwhile, the outcome of catheter ablation of these arrhythmias in patients with SHD remains unclear. This study sought to characterize the outcome of patients with and without SHD undergoing catheter ablation of non-reentrant VA. METHODS:In this single-centre study the acute and long-term outcome of 266 consecutive patients undergoing catheter ablation of non-reentrant VA was investigated. In 41.0% of patients a SHD was present (n?=?109, 80.7% male, age 59.1?±?14.7 years), 59.0% had no SHD (n?=?157; 44.0% male, age 49.9?±?16.5 years). RESULTS:Acute procedural success (absence of spontaneous or provoked VA at the end of procedure and within 48?h after the procedure) was achieved in 89.9% of patients with SHD vs. 94.3% without SHD (p?=?0.238). During a mean follow-up of 34.7?±?15.1 months a repeat catheter ablation was performed in 19.6% of patients with SHD vs. 13.0% without SHD (p?=?0.179). Patients with dilated cardiomyopathy (DCM) were the most likely to require a repeat ablation procedure (32.0% of patients with DCM vs. 13.0% without SHD; p?=?0.022). Periprocedural complications occurred in 5.5% of patients with SHD vs. 5.7% without SHD (p?>?0.999). All complications were managed without sequelae. CONCLUSIONS:The outcome of catheter ablation of non-reentrant VA in patients with SHD appears good and is comparable to patients without SHD. A slightly higher rate of repeat ablations was observed in patients with DCM.

SUBMITTER: Schleberger R

PROVIDER: S-EPMC7076989 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Outcome of catheter ablation of non-reentrant ventricular arrhythmias in patients with and without structural heart disease.

Schleberger Ruben R Jularic Mario M Salzbrunn Tim T Hacke Claudia C Schwarzl Jana M JM Hoffmann Boris A BA Steven Daniel D Willems Stephan S Lemoine Marc D MD Meyer Christian C

European journal of medical research 20200317 1

<h4>Background</h4>Catheter ablation of non-reentrant, commonly termed "idiopathic" ventricular arrhythmias (VA) is highly effective in patients without structural heart disease (SHD). Meanwhile, the outcome of catheter ablation of these arrhythmias in patients with SHD remains unclear. This study sought to characterize the outcome of patients with and without SHD undergoing catheter ablation of non-reentrant VA.<h4>Methods</h4>In this single-centre study the acute and long-term outcome of 266 c ...[more]

PMID: 32183887

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Project description:Background Ultra-high-density mapping enables detailed mechanistic analysis of atrial reentrant tachycardia but has yet to be used to assess circuit conduction velocity (CV) patterns in adults with congenital heart disease. Methods and Results Circuit pathways and central isthmus CVs were calculated from consecutive ultra-high-density isochronal maps at 2 tertiary centers over a 3-year period. Circuits using anatomic versus surgical obstacles were considered separately and pathway length <50th percentile identified small circuits. CV analysis was used to derive a novel index for prediction of postablation conduction block. A total of 136 supraventricular tachycardias were studied (60% intra-atrial reentrant, 14% multiple loop). Circuits with anatomic versus surgical obstacles featured longer pathway length (119 mm; interquartile range [IQR], 80-150 versus 78 mm; IQR, 63-95; P<0.001), faster central isthmus CV (0.1 m/s; IQR, 0.06-0.25 versus 0.07 m/s; IQR, 0.05-0.10; P=0.016), faster non-isthmus CV (0.52 m/s; IQR, 0.33-0.71 versus 0.38 m/s; IQR, 0.27-0.46; P=0.009), and fewer slow isochrones (4; IQR, 2.3-6.8 versus 6; IQR 5-7; P=0.008). Both central isthmus (R2=0.45; P<0.001) and non-isthmus CV (R2=0.71; P<0.001) correlated with pathway length, whereas central isthmus CV <0.15 m/s was ubiquitous for small circuits. Non-isthmus CV in tachycardia correlated with CV during block validation (R2=0.94; P<0.001) and a validation map to tachycardia conduction time ratio >85% predicted isthmus block in all cases. Over >1 year of follow-up, arrhythmia-free survival was better for homogeneous CV patterns (90% versus 57%; P=0.04). Conclusions Ultra-high-density mapping-guided CV analysis distinguishes atrial reentrant patterns in adults with congenital heart disease with surgical obstacles producing slower and smaller circuits. Very slow central isthmus CV may be essential for atrial tachycardia maintenance in small circuits, and non-isthmus conduction time in tachycardia appears to be useful for rapid assessment of postablation conduction block.

Dataset Information

Outcome of catheter ablation of non-reentrant ventricular arrhythmias in patients with and without structural heart disease.

Publications

Outcome of catheter ablation of non-reentrant ventricular arrhythmias in patients with and without structural heart disease.

Similar Datasets

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