Radio-frequency ablation as primary management of well-tolerated sustained monomorphic ventricular tachycardia in patients with structural heart disease and left ventricular ejection fraction over 30%

Philippe Maury, Francesca Baratto, Katja Zeppenfeld, George Klein, Etienne Delacretaz, Frederic Sacher, Etienne Pruvot, Francois Brigadeau, Anne Rollin, Marius Andronache, Giuseppe MacCabelli, Marcin Gawrysiak, Roman Brenner, Andrei Forclaz, Jürg Schlaepfer, Dominique Lacroix, Alexandre Duparc, Pierre Mondoly, Frederic Bouisset, Marc DelayMeleze Hocini, Nicolas Derval, Nicolas Sadoul, Isabelle Magnin-Poull, Didier Klug, Michel Haïssaguerre, Pierre Jaïs, Paolo Della Bella, Christian De Chillou

Research output: Contribution to journalArticlepeer-review

Abstract

Aims Patients with well-tolerated sustained monomorphic ventricular tachycardia (SMVT) and left ventricular ejection fraction (LVEF) over 30% may benefit from a primary strategy of VT ablation without immediate need for a 'back-up' implantable cardioverter-defibrillator (ICD). Methods and results One hundred and sixty-six patients with structural heart disease (SHD), LVEF over 30%, and well-tolerated SMVT (no syncope) underwent primary radiofrequency ablation without ICD implantation at eight European centres. There were 139 men (84%) with mean age 62 ± 15 years and mean LVEF of 50 ± 10%. Fifty-five percent had ischaemic heart disease, 19% non-ischaemic cardiomyopathy, and 12% arrhythmogenic right ventricular cardiomyopathy. Three hundred seventy-eight similar patients were implanted with an ICD during the same period and serve as a control group. All-cause mortality was 12% (20 patients) over a mean follow-up of 32 ± 27 months. Eight patients (40%) died from non-cardiovascular causes, 8 (40%) died from non-arrhythmic cardiovascular causes, and 4 (20%) died suddenly (SD) (2.4% of the population). All-cause mortality in the control group was 12%. Twenty-seven patients (16%) had a non-fatal recurrence at a median time of 5 months, while 20 patients (12%) required an ICD, of whom 4 died (20%). Conclusion Patients with well-tolerated SMVT, SHD, and LVEF > 30% undergoing primary VT ablation without a back-up ICD had a very low rate of arrhythmic death and recurrences were generally non-fatal. These data would support a randomized clinical trial comparing this approach with others incorporating implantation of an ICD as a primary strategy.

Original languageEnglish
Pages (from-to)1479-1485
Number of pages7
JournalEuropean Heart Journal
Volume35
Issue number22
DOIs
Publication statusPublished - Jun 7 2014

Keywords

  • Ablation
  • Implantable cardioverter defibrillator
  • Radio-frequency
  • Sudden death
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

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