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Titolo:
RADIOFREQUENCY CATHETER ABLATION OF SUSTAINED VENTRICULAR-TACHYCARDIAIN IDIOPATHIC DILATED CARDIOMYOPATHY
Autore:
KOTTKAMP H; HINDRICKS G; CHEN X; BRUNN J; WILLEMS S; HAVERKAMP W; BLOCK M; BREITHARDT G; BORGGREFE M;
Indirizzi:
UNIV MUNSTER,MED KLIN & POLIKLIN D-48129 MUNSTER GERMANY UNIV HOSP MUNSTER,DEPT CARDIOL & ANGIOL MUNSTER GERMANY UNIV HOSP MUNSTER,INST ARTERIOSCLEROSIS RES MUNSTER GERMANY
Titolo Testata:
Circulation
fascicolo: 5, volume: 92, anno: 1995,
pagine: 1159 - 1168
SICI:
0009-7322(1995)92:5<1159:RCAOSV>2.0.ZU;2-W
Fonte:
ISI
Lingua:
ENG
Soggetto:
ACCESSORY ATRIOVENTRICULAR PATHWAYS; PRIOR MYOCARDIAL-INFARCTION; PARKINSON-WHITE SYNDROME; HEART-FAILURE; PROGRAMMED STIMULATION; FOLLOW-UP; ACTIVATION; MECHANISMS; REENTRANT; ORIGIN;
Keywords:
TACHYCARDIA; CARDIOMYOPATHY; CATHETER ABLATION;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
52
Recensione:
Indirizzi per estratti:
Citazione:
H. Kottkamp et al., "RADIOFREQUENCY CATHETER ABLATION OF SUSTAINED VENTRICULAR-TACHYCARDIAIN IDIOPATHIC DILATED CARDIOMYOPATHY", Circulation, 92(5), 1995, pp. 1159-1168

Abstract

Background The feasibility of radiofrequency (RF) catheter ablation for the treatment of sustained ventricular tachycardia (VT) in patientswith coronary artery disease and remote myocardial infarction has recently been demonstrated. At present, therapeutic options for VT in patients with idiopathic dilated cardiomyopathy (DCM) include antiarrhythmic drugs and implantable cardioverter/defibrillators (ICD). The purpose of the present study was to investigate the feasibility of RF catheter ablation in patients with idiopathic DCM who could not be adequately treated by conventional treatment modalities because of incessant or frequent, recurrent VT. Methods and Results RF current application for ablation of 9 VTs (mean cycle length, 402+/-78 ms) was attempted in8 patients with idiopathic DCM (4 men, 4 women; mean age, 54+/-6 years; mean left ventricular ejection fraction, 30+/-9%). Inclusion criteria for ablation were incessant VT (n=4) or frequent, recurrent VT reproducibly inducible with programmed electrical stimulation (n=5). Threepatients had suffered aborted sudden cardiac death, and 2 had experienced syncope. Two patients were artificially ventilated and catecholamine dependent for hemodynamic reasons at the time of attempted ablation. Potential target sites for RF current application were identified by detailed endocardial mapping during sinus rhythm, activation and entrainment mapping during VT, and pace mapping. After 7+/-5 RF pulses (range, 2 to 18 pulses; median, 6 pulses) applied with 32+/-7 W for 39+/-9 seconds, 6 of the 9 target VTs (67%) were rendered noninducible (4 of 4 incessant VTs and 2 of 5 chronic recurrent VTs). In 6 patients, VTs with ECG morphologies other than the target VTs were inducible after RF catheter ablation. Seven patients were on antiarrhythmic drugs during the ablation procedure and during the follow-up period of 8+/-5 months (range, 2 to 17 months). One patient received an ICD before RF ablation, 4 patients after RF ablation, and 1 patient after ablation ofan incessant VT and before attempted ablation of frequent, recurrent VTs. One patient underwent heart transplantation 5 months after ablation in end-stage heart failure. There were no acute complications during the mapping and ablation procedure. During the follow-up period, 1 patient had been resuscitated from ventricular fibrillation 6 weeks after ablation and finally died of congestive heart failure 2 weeks later. No further episodes of incessant VT occurred in the patients who hadundergone RF current application for ablation of incessant VT. A complete prevention of VT could be achieved in 2 of 8 patients, whereas in5 patients, VT episodes were stored in the ICD devices during follow-up. Conclusions The results of the present study indicate that RF current application for ablation of VT in a select group of patients with idiopathic DCM is feasible. The efficacy of RF ablation may be high inpatients presenting with incessant VT, whereas the success rate seemsto be only moderate in patients with chronic recurrent VT. In all patients, additional treatment options, including antiarrhythmic drugs, ICDs, and/or heart transplantation, were applied after RF ablation, indicating that RF ablation for this indication may be an adjunctive and not a curative treatment option.

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Documento generato il 23/09/20 alle ore 08:47:02