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 journalArticle

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

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Ventricular Tachycardia
Radio
Stroke Volume
Implantable Defibrillators
Heart Diseases
Mortality
Recurrence
Control Groups
Syncope
Cardiomyopathies
Myocardial Ischemia
Randomized Controlled Trials
Population

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

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

In: European Heart Journal, Vol. 35, No. 22, 07.06.2014, p. 1479-1485.

Research output: Contribution to journalArticle

Maury, P, Baratto, F, Zeppenfeld, K, Klein, G, Delacretaz, E, Sacher, F, Pruvot, E, Brigadeau, F, Rollin, A, Andronache, M, MacCabelli, G, Gawrysiak, M, Brenner, R, Forclaz, A, Schlaepfer, J, Lacroix, D, Duparc, A, Mondoly, P, Bouisset, F, Delay, M, Hocini, M, Derval, N, Sadoul, N, Magnin-Poull, I, Klug, D, Haïssaguerre, M, Jaïs, P, Della Bella, P & De Chillou, C 2014, '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%', European Heart Journal, vol. 35, no. 22, pp. 1479-1485. https://doi.org/10.1093/eurheartj/ehu040
Maury, Philippe ; Baratto, Francesca ; Zeppenfeld, Katja ; Klein, George ; Delacretaz, Etienne ; Sacher, Frederic ; Pruvot, Etienne ; Brigadeau, Francois ; Rollin, Anne ; Andronache, Marius ; MacCabelli, Giuseppe ; Gawrysiak, Marcin ; Brenner, Roman ; Forclaz, Andrei ; Schlaepfer, Jürg ; Lacroix, Dominique ; Duparc, Alexandre ; Mondoly, Pierre ; Bouisset, Frederic ; Delay, Marc ; Hocini, Meleze ; Derval, Nicolas ; Sadoul, Nicolas ; Magnin-Poull, Isabelle ; Klug, Didier ; Haïssaguerre, Michel ; Jaïs, Pierre ; Della Bella, Paolo ; De Chillou, Christian. / 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%. In: European Heart Journal. 2014 ; Vol. 35, No. 22. pp. 1479-1485.
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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.",
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T1 - 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%

AU - Maury, Philippe

AU - Baratto, Francesca

AU - Zeppenfeld, Katja

AU - Klein, George

AU - Delacretaz, Etienne

AU - Sacher, Frederic

AU - Pruvot, Etienne

AU - Brigadeau, Francois

AU - Rollin, Anne

AU - Andronache, Marius

AU - MacCabelli, Giuseppe

AU - Gawrysiak, Marcin

AU - Brenner, Roman

AU - Forclaz, Andrei

AU - Schlaepfer, Jürg

AU - Lacroix, Dominique

AU - Duparc, Alexandre

AU - Mondoly, Pierre

AU - Bouisset, Frederic

AU - Delay, Marc

AU - Hocini, Meleze

AU - Derval, Nicolas

AU - Sadoul, Nicolas

AU - Magnin-Poull, Isabelle

AU - Klug, Didier

AU - Haïssaguerre, Michel

AU - Jaïs, Pierre

AU - Della Bella, Paolo

AU - De Chillou, Christian

PY - 2014/6/7

Y1 - 2014/6/7

N2 - 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.

AB - 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.

KW - Ablation

KW - Implantable cardioverter defibrillator

KW - Radio-frequency

KW - Sudden death

KW - Ventricular tachycardia

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