Nonischemic cardiomyopathy substrate and ventricular tachycardia in the setting of coronary artery disease
Language English Country United States Media print-electronic
Document type Journal Article, Research Support, Non-U.S. Gov't
PubMed
23973949
DOI
10.1016/j.hrthm.2013.08.021
PII: S1547-5271(13)00896-5
Knihovny.cz E-resources
- Keywords
- Ablation, CAD, Coronary disease, EGM, ICD, LBBB, LV, LVOT, MI, MRI, Mapping, NICM, Nonischemic, RBBB, RV, VT, Ventricular tachycardia, coronary artery disease, electrogram, implantable cardioverter-defibrillator, left bundle branch block, left ventricle outflow tract, left ventricle/ventricular, magnetic resonance imaging, myocardial infarction, nonischemic cardiomyopathy, right bundle branch block, right ventricle/ventricular, ventricular tachycardia,
- MeSH
- Cardiomyopathies complications epidemiology physiopathology MeSH
- Catheter Ablation MeSH
- Tachycardia, Ventricular complications epidemiology surgery MeSH
- Humans MeSH
- Body Surface Potential Mapping MeSH
- Follow-Up Studies MeSH
- Coronary Artery Disease complications diagnosis physiopathology MeSH
- Prevalence MeSH
- Prognosis MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Czech Republic epidemiology MeSH
BACKGROUND: Patients with coronary artery disease (CAD) may have ventricular tachycardia (VT) from a separate nonischemic process. Catheter ablation in these patients can be misguided by abnormalities of coronary arteries. OBJECTIVE: To identify (1) the prevalence of unanticipated nonischemic VT in patients with known CAD presenting with VT and (2) the substrate and VT characteristics of this unique subset of patients. METHODS: We examined consecutive patients referred for VT catheter ablation who had a history of myocardial infarction and angiography documented CAD with presumed ischemic VT. Patients with low-voltage zones and/or VT origin inconsistent with CAD distribution were included for further analysis. RESULTS: Of 732 patients, 9 (1.2%) (7 men; median age 74 years; ejection fraction 30%) fulfilled inclusion criteria. Endocardial left ventricular scar inconsistent with CAD distribution was found in 8 patients. In 1 patient, only epicardial left ventricular scar was found. The distribution of low voltage (<1.5 mV) was predominantly around the aortic and mitral valves. Thirty-one VTs were induced in 8 patients. Most VTs had right bundle branch block (68%); of these VTs, 67% had an R/S transition zone later than lead V4 consistent with basal VT origin. Epicardial ablation was necessary in 2 patients. During follow-up (30 [25-39] months), 7 of 9 patients (78%) were free of recurrent VT. CONCLUSIONS: A small but important subgroup of patients with CAD and VT has a nonischemic substrate/etiology for VT. The presence of multiple VTs with basal origin suggests a potential nonischemic perivalvular substrate and possible need for epicardial VT ablation.
References provided by Crossref.org
2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias
2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias
2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias
