Impact of catheter ablation of ventricular tachycardia on survival in patients with ischemic cardiomyopathy
Abstract
Background. Rapid technology progress in electrophysiology has contributed the significant reduction of mortality in patients with life-threatening ventricular tachyarrhythmias. Implantable cardioverter-defibrillators and catheter ablation are mostly relevant. Trials aimed at studying the survival in patients with ventricular tachyarrhythmias have demonstrated the lack of benefits of antiarrhythmic drug therapy combined with the implantation of cardioverter defibrillators in comparison with the catheter ablation group. We present a single-center nonrandomized prospective study to estimate the survival in patients with ventricular tachyarrhythmias associated with ischemic cardiomyopathy after catheter ablation.
Aim – to study the efficacy of catheter ablation and survival in patients with ventricular tachyarrhythmias on the background of ischemic cardiomyopathy.
Material and methods. The study included patients with prior myocardial infarction and documented episodes of sustained ventricular tachyarrhythmias. 72 patients were included (mean age of 64±13 years), 63 of whom were men. The patients were divided into 2 groups: the 1stgroup consisted of 27 (37%) patients with ventricular tachyarrhythmias recurrence after catheter ablation (mean age 62±10 years), the 2nd group included 45 (63%) patients without tachycardia recurrence (mean age 63±12 years). Mean ventricular tachycardia manifestation time was 13±9 years after prior myocardial infarction.
Results. The follow-up lasted for 35±16 months, in 63% of patients there were no ventricular tachyarrhythmias registered. For up to 5 years of follow-up, the overall mortality was 22% (16 patients). Perioperative fatal cases were not recorded. During the first year of follow-up of patients with catheter ablation of electrical storm, four patients experienced ventricular tachycardia recurrences (33%), long-term efficacy of electrical storm elimination was 100%, in 75% of cases the arrhythmias were successfully suppressed.
Conclusions. The 5-year efficacy of catheter ablation of ventricular tachyarrhythmias in the study was 63%, patient survival – 78%. There were no mortality differences between patients with effective catheter ablation and patients with ventricular tachyarrhythmias after radiofrequency ablation.
Keywords:catheter ablation, ventricular tachyarrhythmia, survival, implantable cardioverter-defibrillators
Clin Experiment Surg. Petrovsky J. 2018; 6 (3): 85–92.
doi: 10.24411/2308-1198-2018-13009. Received: 24.04.2018. Accepted: 10.08.2018.
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