TY - JOUR
T1 - Importance of Ventricular Tachycardia Induction and Mapping for Patients Referred for Epicardial Ablation
AU - Nazer, Babak
AU - Woods, Christopher
AU - Dewland, Thomas
AU - Moyers, Brian
AU - Badhwar, Nitish
AU - Gerstenfeld, Edward P.
N1 - Publisher Copyright:
© 2015 Wiley Periodicals, Inc.
Copyright:
Copyright 2016 Elsevier B.V., All rights reserved.
PY - 2015/11
Y1 - 2015/11
N2 - Background Many nonischemic cardiomyopathy (NICMP) patients referred for catheter ablation of ventricular tachycardia (VT) undergo an initial epicardial approach under general anesthesia (GA). However, GA may suppress inducibility and decrease tolerance of induced VT, leaving substrate modification as the sole ablation method. Objectives Determine the utility of a strategy of initial programmed electrical stimulation (PES) under light sedation in patients referred for epicardial ablation of VT. Methods Of 68 NICMP patients referred for VT ablation, 25 were referred specifically for epicardial ablation. All patients underwent PES under conscious sedation, with conversion to GA and epicardial access only if VT morphology and/or endocardial mapping suggested an epicardial substrate. Results VT was induced with PES in 24 of 25 patients (mean age 52 years; 76% male; ejection fraction 38 ± 18%). VT was hemodynamically tolerated in 63% and unstable in 38% of patients. The noninducible/unstable VT patients underwent substrate modification based on voltage and pace mapping. Of the patients with stable VT, 73% were mapped and ablated endocardially (six right ventricle, three left ventricle, one left coronary cusp, one middle cardiac vein), and 33% were successfully ablated in areas of normal endocardial voltage. After ablation, the clinical VT was noninducible in all patients. After mean follow-up of 10 months, 80% were free of implantable cardioverter defibrillator shocks or sustained VT. Conclusions An initial approach of PES and entrainment mapping under conscious sedation is critically important for patients with NICMP referred for epicardial ablation. Empiric ablation of endocardial/epicardial scar would have missed the clinical VT in 20% of patients.
AB - Background Many nonischemic cardiomyopathy (NICMP) patients referred for catheter ablation of ventricular tachycardia (VT) undergo an initial epicardial approach under general anesthesia (GA). However, GA may suppress inducibility and decrease tolerance of induced VT, leaving substrate modification as the sole ablation method. Objectives Determine the utility of a strategy of initial programmed electrical stimulation (PES) under light sedation in patients referred for epicardial ablation of VT. Methods Of 68 NICMP patients referred for VT ablation, 25 were referred specifically for epicardial ablation. All patients underwent PES under conscious sedation, with conversion to GA and epicardial access only if VT morphology and/or endocardial mapping suggested an epicardial substrate. Results VT was induced with PES in 24 of 25 patients (mean age 52 years; 76% male; ejection fraction 38 ± 18%). VT was hemodynamically tolerated in 63% and unstable in 38% of patients. The noninducible/unstable VT patients underwent substrate modification based on voltage and pace mapping. Of the patients with stable VT, 73% were mapped and ablated endocardially (six right ventricle, three left ventricle, one left coronary cusp, one middle cardiac vein), and 33% were successfully ablated in areas of normal endocardial voltage. After ablation, the clinical VT was noninducible in all patients. After mean follow-up of 10 months, 80% were free of implantable cardioverter defibrillator shocks or sustained VT. Conclusions An initial approach of PES and entrainment mapping under conscious sedation is critically important for patients with NICMP referred for epicardial ablation. Empiric ablation of endocardial/epicardial scar would have missed the clinical VT in 20% of patients.
KW - epicardial ablation
KW - nonischemic cardiomyopathy
KW - ventricular tachycardia
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U2 - 10.1111/pace.12703
DO - 10.1111/pace.12703
M3 - Article
C2 - 26228002
AN - SCOPUS:84945453521
VL - 38
SP - 1333
EP - 1342
JO - PACE - Pacing and Clinical Electrophysiology
JF - PACE - Pacing and Clinical Electrophysiology
SN - 0147-8389
IS - 11
ER -