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 A, Paglino G, Oloriz T, Maccabelli G, Baratto F, Vergara P, Bisceglia C, Anguera I, Sala S, Sora N, Dallaglio P, Marzi A, Trevisi N, Mazzone P, and Della Bella P
- Subjects
- Aged, Chronic Disease, Comorbidity, Coronary Angiography, Coronary Occlusion diagnosis, Coronary Occlusion mortality, Electrophysiologic Techniques, Cardiac, Female, Hospital Mortality, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Myocardial Infarction diagnosis, Myocardial Infarction mortality, Proportional Hazards Models, Prospective Studies, Recurrence, Retrospective Studies, Risk Factors, Spain, Tachycardia, Ventricular complications, Tachycardia, Ventricular diagnosis, Tachycardia, Ventricular mortality, Time Factors, Treatment Outcome, Catheter Ablation adverse effects, Catheter Ablation mortality, Coronary Occlusion complications, Myocardial Infarction etiology, Tachycardia, Ventricular surgery
- Abstract
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 cm(2) vs. 19 cm(2) , 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., (© 2015 Wiley Periodicals, Inc.)
- Published
- 2015
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