1. Impact of a Chronic Total Occlusion in an Infarct-Related Artery on the Long-Term Outcome of Ventricular Tachycardia Ablation.
- Author
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DI MARCO, ANDREA, PAGLINO, GABRIELE, OLORIZ, TERESA, MACCABELLI, GIUSEPPE, BARATTO, FRANCESCA, VERGARA, PASQUALE, BISCEGLIA, CATERINA, ANGUERA, IGNASI, SALA, SIMONE, SORA, NICOLETA, DALLAGLIO, PAOLO, MARZI, ALESSANDRA, TREVISI, NICOLA, MAZZONE, PATRIZIO, and DELLA BELLA, PAOLO
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MYOCARDIAL infarction complications , *VENTRICULAR tachycardia , *DISEASE relapse , *ACADEMIC medical centers , *ARTERIAL occlusions , *BODY surface mapping , *CATHETER ablation , *CHI-squared test , *CONFIDENCE intervals , *CORONARY arteries , *ELECTROCARDIOGRAPHY , *FISHER exact test , *LONGITUDINAL method , *SCIENTIFIC observation , *REGRESSION analysis , *STATISTICS , *SURVIVAL analysis (Biometry) , *T-test (Statistics) , *DATA analysis , *DATA analysis software , *DESCRIPTIVE statistics , *CORONARY angiography , *DISEASE complications , *THERAPEUTICS - Abstract
IRA-CTO and VT Ablation Introduction In patients with a prior myocardial infarction (MI), angiographic predictors of ventricular tachycardia (VT) recurrence after ablation are lacking. Recently, a proarrhythmic effect of a chronic total occlusion (CTO) in a coronary artery has been suggested. Methods and Results A total of 191 patients with prior MI were referred to our Hospital between 2010 and June 2013 for a first ablation of VT. Of these, 84 patients (44%) with stable coronary artery disease that underwent a coronary angiography during the index hospitalization were included in this study. A CTO in an infarct-related artery (IRA-CTO) was present in 47 patients (56%). Patients with and without IRA-CTO did not differ in terms of comorbidities, severity of heart failure, presentation of VT or acute outcome of ablation, that was completely successful in 93% of cases. At electroanatomic mapping, IRA-CTO was associated with greater scar and especially with greater area of border zone (34 cm2 vs. 19 cm2, P = 0.001). Median follow-up was 19 months (IQR 18). At follow-up, patients with IRA-CTO had a significantly higher rate of VT recurrence (47% vs. 16%, P = 0.003). At multivariate analysis, IRA-CTO resulted to be an independent predictor of VT recurrence after ablation (HR 4.05, P = 0.004). Conclusions IRA-CTO is an independent predictor of VT recurrence after ablation and identifies a subgroup of patients with high recurrence rate despite a successful procedure. IRA-CTO is associated with greater scars and border zone area; however, this association does not completely justify its proarrhythmic effect. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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