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Recurrent ventricular tachycardia after cardiac sympathetic denervation: Prolonged cycle length with improved hemodynamic tolerance and ablation outcomes.
- Source :
-
Journal of Cardiovascular Electrophysiology . Sep2020, Vol. 31 Issue 9, p2382-2392. 11p. 4 Charts, 2 Graphs, 1 Map. - Publication Year :
- 2020
-
Abstract
- Introduction: Cardiac sympathetic denervation (CSD) is utilized for the management of ventricular tachycardia (VT) in structural heart disease when refractory to radiofrequency ablation (RFA) or when patient/VT characteristics are not conducive to RFA. Methods: We studied consecutive patients who underwent CSD at our institution from 2009 to 2018 with VT requiring repeat RFA post‐CSD. Patient demographics, VT/procedural characteristics, and outcomes were assessed. Results: Ninety‐six patients had CSD, 16 patients underwent RFA for VT post‐CSD. There were 15 male and 1 female patients with mean age of 54.2 ± 13.2 years. Fourteen patients had nonischemic cardiomyopathy. A mean of 2.0 ± 0.8 RFAs for VT was unsuccessful before the patient undergoing CSD. The median time between CSD and RFA was 104 days (interquartile range [IQR] = 15–241). The clinical VT cycle length was significantly increased after CSD both spontaneously on ECG and/or ICD interrogation (355 ± 73 ms pre‐CSD vs. 422 ± 94 ms post‐CSD, p =.001) and intraprocedurally (406 ± 86 ms pre‐CSD vs. 457 ± 88 ms post‐CSD, p =.03). Two patients had polymorphic and 14 had monomorphic VT (MMVT) pre‐CSD, and all patients had MMVT post‐CSD. The proportion of mappable, hemodynamically stable VTs increased from 35% during pre‐CSD RFA to 58% during post‐CSD RFA (p =.038). At median follow‐up of 413 days (IQR = 43–1840) after RFA, eight patients had no further VT. Conclusion: RFA for recurrent MMVT post‐CSD is a reasonable treatment option with intermediate‐term clinical success in 50% of patients. Clinical VT cycle length was significantly increased after CSD with associated improvement in mappable, hemodynamically tolerated VT during RFA. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 10453873
- Volume :
- 31
- Issue :
- 9
- Database :
- Academic Search Index
- Journal :
- Journal of Cardiovascular Electrophysiology
- Publication Type :
- Academic Journal
- Accession number :
- 145514060
- Full Text :
- https://doi.org/10.1111/jce.14624