Drug-refractory ventricular tachycardias after myocarditis: endocardial and epicardial radiofrequency catheter ablation.

Abstract

BACKGROUND:

Ventricular tachycardia (VT) is a significant therapeutic challenge in patients with myocarditis. This study aimed to assess the efficacy and safety of radiofrequency catheter ablation (RFCA) of VT in patients with myocarditis.

METHODS AND RESULTS:

We enrolled 20 patients (15 men; age, 42 [28-52] years) with a history of biopsy-proven viral myocarditis and drug-refractory VT; 5 patients presented with electrical storm. The median left ventricular ejection fraction was 55% (45-60%). All patients underwent endocardial RFCA with an irrigated catheter, using contact electroanatomic mapping. Recurrence of sustained VT after endocardial RFCA was treated with additional epicardial RFCA. Endocardial RFCA was acutely successful in 14 patients (70%) while in the remaining 6 (30%) clinical VT was successfully ablated by epicardial RFCA. In 1 patient, hemodynamic instability required an intra-aortic balloon pump to complete RFCA. No major complication occurred during or after RFCA. Over a median follow-up time of 28 (11-48) months, 18 patients (90%) remained free of sustained VT; 2 patients (10%, both with baseline left ventricular ejection fraction≤35%) died of acute heart failure unrelated to ventricular arrhythmias.

CONCLUSIONS:

In patients with myocarditis, RFCA of drug-refractory VT is feasible, safe, and effective. Epicardial RFCA should be considered as an important therapeutic option to increase success rate.

• Authors: Antonio Dello Russo, Michela Casella, Maurizio Pieroni, Gemma Pelargonio, Stefano Bartoletti, Pasquale Santangeli, Martina Zucchetti, Ester Innocenti, Luigi Di Biase, Corrado Carbucicchio, Fulvio Bellocci, Cesare Fiorentini, Andrea Natale, Claudio Tondo
• Journal: Circulation. Arrhythmia and electrophysiology (Circ Arrhythm Electrophysiol) Vol. 5 Issue 3 Pg. 492-8 (Jun 01 2012) ISSN: 1941-3084 [Electronic] United States
• PMID: 22294614 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Anti-Arrhythmia Agents

Topics

• Adult
• Anti-Arrhythmia Agents (therapeutic use)
• Cardiac Catheterization
• Catheter Ablation (methods)
• Drug Tolerance
• Echocardiography, Doppler, Color
• Electrocardiography
• Endocardium (surgery)
• Female
• Heart Conduction System (physiopathology, surgery)
• Humans
• Male
• Middle Aged
• Myocarditis (complications, diagnosis)
• Pericardium (surgery)
• Retrospective Studies
• Tachycardia, Ventricular (diagnosis, etiology, therapy)
• Treatment Outcome