TY - JOUR
T1 - Drug-refractory ventricular tachycardias after myocarditis
T2 - Endocardial and epicardial radiofrequency catheter ablation
AU - Russo, Antonio Dello
AU - Casella, Michela
AU - Pieroni, Maurizio
AU - Pelargonio, Gemma
AU - Bartoletti, Stefano
AU - Santangeli, Pasquale
AU - Zucchetti, Martina
AU - Innocenti, Ester
AU - Biase, Luigi Di
AU - Carbucicchio, Corrado
AU - Bellocci, Fulvio
AU - Fiorentini, Cesare
AU - Natale, Andrea
AU - Tondo, Claudio
N1 - Copyright:
Copyright 2013 Elsevier B.V., All rights reserved.
PY - 2012/6
Y1 - 2012/6
N2 - Background-Ventricular tachycardia (VT) is a significant therapeutic challenge in patients with myocarditis. This study aimed to assess the efficacy and safety of radiofrequency catheter ablation (RFCA) of VT in patients with myocarditis. Methods and Results-We enrolled 20 patients (15 men; age, 42 [28-52] years) with a history of biopsy- proven viral myocarditis and drug- refractory VT; 5 patients presented with electrical storm. The median left ventricular ejection fraction was 55% (45-60%). All patients underwent endocardial RFCA with an irrigated catheter, using contact electroanatomic mapping. Recurrence of sustained VT after endocardial RFCA was treated with additional epicardial RFCA. Endocardial RFCA was acutely successful in 14 patients (70%) while in the remaining 6 (30%) clinical VT was successfully ablated by epicardial RFCA. In 1 patient, hemodynamic instability required an intra- aortic balloon pump to complete RFCA. No major complication occurred during or after RFCA. Over a median follow- up time of 28 (11-48) months, 18 patients (90%) remained free of sustained VT; 2 patients (10%, both with baseline left ventricular ejection fraction ≤35%) died of acute heart failure unrelated to ventricular arrhythmias. Conclusions-In patients with myocarditis, RFCA of drug- refractory VT is feasible, safe, and effective. Epicardial RFCA should be considered as an important therapeutic option to increase success rate. (Circ Arrhythm Electrophysiol. 2012;5:492-498.)
AB - Background-Ventricular tachycardia (VT) is a significant therapeutic challenge in patients with myocarditis. This study aimed to assess the efficacy and safety of radiofrequency catheter ablation (RFCA) of VT in patients with myocarditis. Methods and Results-We enrolled 20 patients (15 men; age, 42 [28-52] years) with a history of biopsy- proven viral myocarditis and drug- refractory VT; 5 patients presented with electrical storm. The median left ventricular ejection fraction was 55% (45-60%). All patients underwent endocardial RFCA with an irrigated catheter, using contact electroanatomic mapping. Recurrence of sustained VT after endocardial RFCA was treated with additional epicardial RFCA. Endocardial RFCA was acutely successful in 14 patients (70%) while in the remaining 6 (30%) clinical VT was successfully ablated by epicardial RFCA. In 1 patient, hemodynamic instability required an intra- aortic balloon pump to complete RFCA. No major complication occurred during or after RFCA. Over a median follow- up time of 28 (11-48) months, 18 patients (90%) remained free of sustained VT; 2 patients (10%, both with baseline left ventricular ejection fraction ≤35%) died of acute heart failure unrelated to ventricular arrhythmias. Conclusions-In patients with myocarditis, RFCA of drug- refractory VT is feasible, safe, and effective. Epicardial RFCA should be considered as an important therapeutic option to increase success rate. (Circ Arrhythm Electrophysiol. 2012;5:492-498.)
KW - Catheter ablation
KW - Myocarditis
KW - Ventricular tachycardia
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U2 - 10.1161/CIRCEP.111.965012
DO - 10.1161/CIRCEP.111.965012
M3 - Article
C2 - 22294614
AN - SCOPUS:84863651678
SN - 1941-3149
VL - 5
SP - 492
EP - 498
JO - Circulation: Arrhythmia and Electrophysiology
JF - Circulation: Arrhythmia and Electrophysiology
IS - 3
ER -