Elimination of local abnormal ventricular activities: a new end point for substrate modification in patients with scar-related ventricular tachycardia.

Détails

Ressource 1Télécharger: BIB_47B80039E4EA.P001.pdf (2369.78 [Ko])
Etat: Serval
Version: Final published version
ID Serval
serval:BIB_47B80039E4EA
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Elimination of local abnormal ventricular activities: a new end point for substrate modification in patients with scar-related ventricular tachycardia.
Périodique
Circulation
Auteur(s)
Jaïs P., Maury P., Khairy P., Sacher F., Nault I., Komatsu Y., Hocini M., Forclaz A., Jadidi A.S., Weerasooryia R., Shah A., Derval N., Cochet H., Knecht S., Miyazaki S., Linton N., Rivard L., Wright M., Wilton S.B., Scherr D., Pascale P., Roten L., Pederson M., Bordachar P., Laurent F., Kim S.J., Ritter P., Clementy J., Haïssaguerre M.
ISSN
1524-4539 (Electronic)
ISSN-L
0009-7322
Statut éditorial
Publié
Date de publication
2012
Peer-reviewed
Oui
Volume
125
Numéro
18
Pages
2184-2196
Langue
anglais
Notes
Publication types: Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't Publication Status: ppublish
Résumé
BACKGROUND: Catheter ablation of ventricular tachycardia (VT) is effective and particularly useful in patients with frequent defibrillator interventions. Various substrate modification techniques have been described for unmappable or hemodynamically intolerable VT. Noninducibility is the most frequently used end point but is associated with significant limitations, so the optimal end point remains unclear. We hypothesized that elimination of local abnormal ventricular activities (LAVAs) during sinus rhythm or ventricular pacing would be a useful and effective end point for substrate-based VT ablation. As an adjunct to this strategy, we used a new high-density mapping catheter and frequently used epicardial mapping.
METHODS AND RESULTS: Seventy patients (age, 67±11 years; 7 female) with VT and structurally abnormal ventricle(s) were prospectively enrolled. Conventional mapping was performed in sinus rhythm in all, and a high-density Pentaray mapping catheter was used in the endocardium (n=35) and epicardially. LAVAs were recorded in 67 patients (95.7%; 95% confidence interval, 89.2-98.9). Catheter ablation was performed targeting LAVA with an irrigated-tip catheter placed endocardially via a transseptal or retrograde aortic approach or epicardially via the subxiphoid approach. LAVAs were successfully abolished or dissociated in 47 of 67 patients (70.1%; 95% confidence interval, 58.7-80.1). In multivariate analysis, LAVA elimination was independently associated with a reduction in recurrent VT or death (hazard ratio, 0.49; 95% confidence interval, 0.26-0.95; P=0.035) during long-term follow-up (median, 22 months).
CONCLUSIONS: LAVAs can be identified in most patients with scar-related VT. Elimination of LAVAs is feasible and safe and is associated with superior survival free from recurrent VT.
Mots-clé
Aged, Body Surface Potential Mapping/methods, Catheter Ablation/instrumentation, Catheter Ablation/methods, Cicatrix/surgery, Epicardial Mapping, Female, Humans, Male, Middle Aged, Reoperation/instrumentation, Reoperation/methods, Treatment Outcome, Ventricular Fibrillation/mortality, Ventricular Fibrillation/surgery
Pubmed
Open Access
Oui
Création de la notice
12/06/2014 16:06
Dernière modification de la notice
08/05/2019 18:01
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