Irrigated radiofrequency catheter ablation guided by electroanatomic mapping for recurrent ventricular tachycardia after myocardial infarction the multicenter thermocool ventricular tachycardia ablation trial

William G. Stevenson, David J. Wilber, Andrea Natale, Warren M. Jackman, Francis E. Marchlinski, Timothy Talbert, Mario D. Gonzalez, Seth J. Worley, Emile G. Daoud, Chun Hwang, Claudio Schuger, Thomas E. Bump, Mohammad Jazayeri, Gery F. Tomassoni, Harry A. Kopelman, Kyoko Soejima, Hiroshi Nakagawa

Research output: Contribution to journalArticle

461 Citations (Scopus)

Abstract

Recurrent ventricular tachycardia (VT) is an important cause of mortality and morbidity late after myocardial infarction. With frequent use of implantable cardioverter-defibrillators, these VTs are often poorly defined and not tolerated for mapping, factors previously viewed as relative contraindications to ablation. This observational multicenter study assessed the outcome of VT ablation with a saline-irrigated catheter combined with an electroanatomic mapping system. Methods and Results-Two hundred thirty-one patients (median LV ejection fraction, 0.25; heart failure in 62%) with recurrent episodes of monomorphic VT (median, 11 in the preceding 6 months) caused by prior myocardial infarction were enrolled. All inducible monomorphic VTs with a rate approximating or slower than any spontaneous VTs were targeted for ablation guided by electroanatomic mapping during sinus rhythm and/or VT. Patients were not excluded for multiple VTs (median, 3 per patient) or unmappable VT (present in 69% of patients). Ablation abolished all inducible VTs in 49% of patients. The primary end point of freedom from recurrent incessant VT or intermittent VT after 6 months of follow-up was achieved for 123 patients (53%). In 142 patients with implantable cardioverter-defibrillators before and after ablation for intermittent VT who survived 6 months, VT episodes were reduced from a median of 11.5 to 0 (P<0.0001). The 1-year mortality rate was 18%, with 72.5% of deaths attributed to ventricular arrhythmias or heart failure. The procedure mortality rate was 3%, with no strokes. Conclusions-Catheter ablation is a reasonable option to reduce episodes of recurrent VT in patients with prior myocardial infarction, even when multiple and/or unmappable VTs are present. This population remains at high risk for death, warranting surveillance and further study.

Original languageEnglish (US)
Pages (from-to)2773-2782
Number of pages10
JournalCirculation
Volume118
Issue number25
DOIs
StatePublished - Dec 23 2008

Fingerprint

Catheter Ablation
Ventricular Tachycardia
Myocardial Infarction
Implantable Defibrillators
Mortality
Heart Failure
Sinus Tachycardia
Multicenter Studies
Observational Studies
Cardiac Arrhythmias
Catheters
Stroke
Morbidity

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Stevenson, William G. ; Wilber, David J. ; Natale, Andrea ; Jackman, Warren M. ; Marchlinski, Francis E. ; Talbert, Timothy ; Gonzalez, Mario D. ; Worley, Seth J. ; Daoud, Emile G. ; Hwang, Chun ; Schuger, Claudio ; Bump, Thomas E. ; Jazayeri, Mohammad ; Tomassoni, Gery F. ; Kopelman, Harry A. ; Soejima, Kyoko ; Nakagawa, Hiroshi. / Irrigated radiofrequency catheter ablation guided by electroanatomic mapping for recurrent ventricular tachycardia after myocardial infarction the multicenter thermocool ventricular tachycardia ablation trial. In: Circulation. 2008 ; Vol. 118, No. 25. pp. 2773-2782.
@article{ed3d8003ba5648808b65450e0fc3e509,
title = "Irrigated radiofrequency catheter ablation guided by electroanatomic mapping for recurrent ventricular tachycardia after myocardial infarction the multicenter thermocool ventricular tachycardia ablation trial",
abstract = "Recurrent ventricular tachycardia (VT) is an important cause of mortality and morbidity late after myocardial infarction. With frequent use of implantable cardioverter-defibrillators, these VTs are often poorly defined and not tolerated for mapping, factors previously viewed as relative contraindications to ablation. This observational multicenter study assessed the outcome of VT ablation with a saline-irrigated catheter combined with an electroanatomic mapping system. Methods and Results-Two hundred thirty-one patients (median LV ejection fraction, 0.25; heart failure in 62{\%}) with recurrent episodes of monomorphic VT (median, 11 in the preceding 6 months) caused by prior myocardial infarction were enrolled. All inducible monomorphic VTs with a rate approximating or slower than any spontaneous VTs were targeted for ablation guided by electroanatomic mapping during sinus rhythm and/or VT. Patients were not excluded for multiple VTs (median, 3 per patient) or unmappable VT (present in 69{\%} of patients). Ablation abolished all inducible VTs in 49{\%} of patients. The primary end point of freedom from recurrent incessant VT or intermittent VT after 6 months of follow-up was achieved for 123 patients (53{\%}). In 142 patients with implantable cardioverter-defibrillators before and after ablation for intermittent VT who survived 6 months, VT episodes were reduced from a median of 11.5 to 0 (P<0.0001). The 1-year mortality rate was 18{\%}, with 72.5{\%} of deaths attributed to ventricular arrhythmias or heart failure. The procedure mortality rate was 3{\%}, with no strokes. Conclusions-Catheter ablation is a reasonable option to reduce episodes of recurrent VT in patients with prior myocardial infarction, even when multiple and/or unmappable VTs are present. This population remains at high risk for death, warranting surveillance and further study.",
author = "Stevenson, {William G.} and Wilber, {David J.} and Andrea Natale and Jackman, {Warren M.} and Marchlinski, {Francis E.} and Timothy Talbert and Gonzalez, {Mario D.} and Worley, {Seth J.} and Daoud, {Emile G.} and Chun Hwang and Claudio Schuger and Bump, {Thomas E.} and Mohammad Jazayeri and Tomassoni, {Gery F.} and Kopelman, {Harry A.} and Kyoko Soejima and Hiroshi Nakagawa",
year = "2008",
month = "12",
day = "23",
doi = "10.1161/CIRCULATIONAHA.108.788604",
language = "English (US)",
volume = "118",
pages = "2773--2782",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "25",

}

Stevenson, WG, Wilber, DJ, Natale, A, Jackman, WM, Marchlinski, FE, Talbert, T, Gonzalez, MD, Worley, SJ, Daoud, EG, Hwang, C, Schuger, C, Bump, TE, Jazayeri, M, Tomassoni, GF, Kopelman, HA, Soejima, K & Nakagawa, H 2008, 'Irrigated radiofrequency catheter ablation guided by electroanatomic mapping for recurrent ventricular tachycardia after myocardial infarction the multicenter thermocool ventricular tachycardia ablation trial', Circulation, vol. 118, no. 25, pp. 2773-2782. https://doi.org/10.1161/CIRCULATIONAHA.108.788604

Irrigated radiofrequency catheter ablation guided by electroanatomic mapping for recurrent ventricular tachycardia after myocardial infarction the multicenter thermocool ventricular tachycardia ablation trial. / Stevenson, William G.; Wilber, David J.; Natale, Andrea; Jackman, Warren M.; Marchlinski, Francis E.; Talbert, Timothy; Gonzalez, Mario D.; Worley, Seth J.; Daoud, Emile G.; Hwang, Chun; Schuger, Claudio; Bump, Thomas E.; Jazayeri, Mohammad; Tomassoni, Gery F.; Kopelman, Harry A.; Soejima, Kyoko; Nakagawa, Hiroshi.

In: Circulation, Vol. 118, No. 25, 23.12.2008, p. 2773-2782.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Irrigated radiofrequency catheter ablation guided by electroanatomic mapping for recurrent ventricular tachycardia after myocardial infarction the multicenter thermocool ventricular tachycardia ablation trial

AU - Stevenson, William G.

AU - Wilber, David J.

AU - Natale, Andrea

AU - Jackman, Warren M.

AU - Marchlinski, Francis E.

AU - Talbert, Timothy

AU - Gonzalez, Mario D.

AU - Worley, Seth J.

AU - Daoud, Emile G.

AU - Hwang, Chun

AU - Schuger, Claudio

AU - Bump, Thomas E.

AU - Jazayeri, Mohammad

AU - Tomassoni, Gery F.

AU - Kopelman, Harry A.

AU - Soejima, Kyoko

AU - Nakagawa, Hiroshi

PY - 2008/12/23

Y1 - 2008/12/23

N2 - Recurrent ventricular tachycardia (VT) is an important cause of mortality and morbidity late after myocardial infarction. With frequent use of implantable cardioverter-defibrillators, these VTs are often poorly defined and not tolerated for mapping, factors previously viewed as relative contraindications to ablation. This observational multicenter study assessed the outcome of VT ablation with a saline-irrigated catheter combined with an electroanatomic mapping system. Methods and Results-Two hundred thirty-one patients (median LV ejection fraction, 0.25; heart failure in 62%) with recurrent episodes of monomorphic VT (median, 11 in the preceding 6 months) caused by prior myocardial infarction were enrolled. All inducible monomorphic VTs with a rate approximating or slower than any spontaneous VTs were targeted for ablation guided by electroanatomic mapping during sinus rhythm and/or VT. Patients were not excluded for multiple VTs (median, 3 per patient) or unmappable VT (present in 69% of patients). Ablation abolished all inducible VTs in 49% of patients. The primary end point of freedom from recurrent incessant VT or intermittent VT after 6 months of follow-up was achieved for 123 patients (53%). In 142 patients with implantable cardioverter-defibrillators before and after ablation for intermittent VT who survived 6 months, VT episodes were reduced from a median of 11.5 to 0 (P<0.0001). The 1-year mortality rate was 18%, with 72.5% of deaths attributed to ventricular arrhythmias or heart failure. The procedure mortality rate was 3%, with no strokes. Conclusions-Catheter ablation is a reasonable option to reduce episodes of recurrent VT in patients with prior myocardial infarction, even when multiple and/or unmappable VTs are present. This population remains at high risk for death, warranting surveillance and further study.

AB - Recurrent ventricular tachycardia (VT) is an important cause of mortality and morbidity late after myocardial infarction. With frequent use of implantable cardioverter-defibrillators, these VTs are often poorly defined and not tolerated for mapping, factors previously viewed as relative contraindications to ablation. This observational multicenter study assessed the outcome of VT ablation with a saline-irrigated catheter combined with an electroanatomic mapping system. Methods and Results-Two hundred thirty-one patients (median LV ejection fraction, 0.25; heart failure in 62%) with recurrent episodes of monomorphic VT (median, 11 in the preceding 6 months) caused by prior myocardial infarction were enrolled. All inducible monomorphic VTs with a rate approximating or slower than any spontaneous VTs were targeted for ablation guided by electroanatomic mapping during sinus rhythm and/or VT. Patients were not excluded for multiple VTs (median, 3 per patient) or unmappable VT (present in 69% of patients). Ablation abolished all inducible VTs in 49% of patients. The primary end point of freedom from recurrent incessant VT or intermittent VT after 6 months of follow-up was achieved for 123 patients (53%). In 142 patients with implantable cardioverter-defibrillators before and after ablation for intermittent VT who survived 6 months, VT episodes were reduced from a median of 11.5 to 0 (P<0.0001). The 1-year mortality rate was 18%, with 72.5% of deaths attributed to ventricular arrhythmias or heart failure. The procedure mortality rate was 3%, with no strokes. Conclusions-Catheter ablation is a reasonable option to reduce episodes of recurrent VT in patients with prior myocardial infarction, even when multiple and/or unmappable VTs are present. This population remains at high risk for death, warranting surveillance and further study.

UR - http://www.scopus.com/inward/record.url?scp=58249143480&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=58249143480&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.108.788604

DO - 10.1161/CIRCULATIONAHA.108.788604

M3 - Article

C2 - 19064682

AN - SCOPUS:58249143480

VL - 118

SP - 2773

EP - 2782

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 25

ER -