Key result
Recurrent ventricular tachyarrhythmias after catheter ablation were associated with a significantly smaller area of dense scar (23 vs 41 cm2) and shorter clinical tachycardia cycle length.
Observational (n=72)
No
In patients undergoing catheter ablation for post-infarction ventricular tachycardia, recurrence is predicted by anterior MI location, longer ischemic history, shorter VT cycle length, scar heterogeneity, and a smaller dense scar area.
May identify higher-risk post-MI VT patients for closer monitoring after ablation; leaves open whether scar metrics should guide ablation strategy.
Aim. To find out the clinical and electrophysiological predictors of recurrent ventricular tachyarrhythmias (VTA) after catheter homogenization of post-infarction scar areas. Material and methods . Patients included, with myocardial infarction (MI) in anamnesis and documented sustained VTA, regardless effective treatment by implantable cardioverter-defibrillator. Totally, 72 patients included (mean age 64±13 y.o.), of those 63 males with postinfarction VTA. In 12 cases there were“electrical storms” demanded urgent catheter management. In such patients, the extended catheter homogenization of the scar was performed, that is ablation of all conduction channels, anomalous potentials and surrounding ablation of infarction zone. Patients were selected to 2 groups according to recurrent VT in post-surgery period. First group included 27 (37%) VTA recurrent patients, mean age 62±10 y.o. Second group included 45 patients (63%) with non tachyarrhythmias recurrence, mean age 63±12 y.o. The evaluation was done, of the selected parameters with the aim to define predictors of rhythm disorders recurrence. Results. Main clinical predictors of VTA recurrence after catheter ablation were the duration of post MI period and its anterior localization. Full area of the scar surface (bipolar voltage lower 1,5 mV) was comparable in patients with recurrent VT and with none (66±51 cm 2 vs 82±49 cm 2 ). However the area of the dense scar (bipolar amplitude ≤0,5 mV) and percent of the dense scar in relation to entire scar was significantly smaller in the recurrence group (group 1 — 23±22 cm 2 and 24±18%, in group 2 — 41±22 cm 2 and 45±21%; p<0,05). The differences were found in the cycle length of clinical VTA assessment in groups 1 and 2 (290±62 and 330±93 ms, respectively, p<0,05). Conclusion. The analysis that was done, made it to define the following variables and VT predictors: localization of the MI (anterior vs inferior), duration of ischemic anamnesis, cycle of clinical VT, non-homogeneity of the scar, area of the fractionized potentials and delayed potentials of electrograms, area of the dense scar.
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Tatarsky et al. (2017) conducted an observational in Post-infarction ventricular tachyarrhythmias (n=72). Clinical and electrophysiological predictors (e.g., dense scar area, cycle length) vs. Patients without VTA recurrence was evaluated on Area of dense scar (bipolar amplitude ≤0.5 mV) in patients with vs without VTA recurrence (p=<0.05). Recurrent ventricular tachyarrhythmias after catheter ablation were associated with a significantly smaller area of dense scar (23 vs 41 cm2) and shorter clinical tachycardia cycle length.
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