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Long-term outcome of substrate-based ablation in patients with recurrent ICD therapy and dilated cardiomyopathy: experience with high-density mapping
Session:
Painel 4 - Arritmologia 7
Speaker:
Mário Martins Oliveira
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme:
08.4 Ventricular Arrhythmias and SCD - Treatment
Session Type:
Posters
FP Number:
---
Authors:
Mário Martins Oliveira; Pedro Silva Cunha; Bruno Tereno Valente; Guilherme Portugal; Madalena Coutinho Cruz; Ana Lousinha; Inês Grácio De Almeida; Mariana Pereira; Ana Sofia Delgado; Rui Cruz Ferreira
Abstract
<p>Recurrent ventricular tachydysrhythmias (VT) episodes have a negative impact in the clinical outcome of implantable cardioverter-defibrillator (ICD) patients (P). Modification of the arrhythmogenic substrate has been used as a promising approach for treating recurrent VTs, especially in P with ischemic cardiomyopathy. <strong>Aim:</strong> to analyze long-term results of a VT substrate-based ablation using high-density mapping in P with left ventricular (LV) dysfunction and recurrent appropriate ICD therapy. <strong>Methods:</strong> 20P (16 men, non-ischemic cardiomyopathy 65%, 58±14 years, LV ejection fraction 33±6%) and repetitive appropriate shocks (≥2 shocks/24h) despite antiarrhythmic drug therapy and optimal heart failure medication. All P underwent a protocol of ventricular programmed stimulation (600 ms/S3) to obtain baseline VT documentation. A sinus rhythm (SR) voltage map was created with 3D electroanatomic mapping system (<em>CARTO</em>) using a high-density mapping catheter (PentaRay) to delineate areas of scarred myocardium (<em>ventricular bipolar voltage ≤0,5 mV – dense scar; 0,5-1,5 mV – border zone; </em><em>≥1,5 mV – healthy tissue</em>) and provide high-resolution electrophysiological mapping. The substrate modification included elimination of local abnormal ventricular activities (LAVA) during SR (<em>fractionated, splited, low-amplitude/long-lasting, late potentials, pre-systolic</em>) and linear ablation to obtain scars homogenization and scar dechanneling. Pace-mapping techniques were used when capture was possible. LV approach was retrograde in 9 cases, transeptal in 5 and endo-epicardial in 4 cases. In 2P the ablation was performed inside the right ventricle. <strong>Results</strong>: LAVA and scar areas were modified in all P. The mean duration of the procedure was 149 mn (105-220mn), with radiofrequency ranging from 18 to 70 mn (mean 33 min) and a mean fluoroscopy time of 15 mn. Non-inducibility was achieved in 75% of the cases (in 4P - haemodynamic deterioration/LV assistance device - VT inducibility was not performed). There were 2 pericardial tamponades drained successfully. During a follow-up of 50±24 months, 73% had no VT recurrences. Among the 7P with recurrences, 3P underwent redo ablation and 7P, with less VT episodes, received ICD therapy. There were 5 hospital readmissions due to HF decompensation, 1P died in the first week after unsuccessful ablation of VT storm and 4P died from pneumonia. <strong>Conclusion:</strong> Catheter ablation based on substrate modification is feasible and safe in P with LV dysfunction. This approach may be of clinical relevance, with potential long-term benefits in reducing VT recurrence</p>
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