VT in Hypertrophic Cardiomyopathy and LV Aneurysm

Study Questions:

What are the characteristics and results of radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) in patients with hypertrophic cardiomyopathy (HCM) and left ventricular apical aneurysm (AA)?

Methods:

Fifteen patients with HCM and AA underwent RFCA for VT at five different institutions in Japan.

Results:

Late potentials in the AA were recorded in 12 patients (80%). Although epicardial or intramural origin of VT was suspected in seven patients, endocardial RFCA successfully suppressed the VT at the low-voltage area border (n = 10) or within the low-voltage area (n = 2). In all patients, clinical VT became non-inducible after RFCA. VT recurrence was observed in two patients (13.3%) during the 12-month follow-up period.

Conclusions:

In patients with HCM and AA, endocardial RFCA of AA effectively suppressed monomorphic VT, which was related to AA.

Perspective:

LV AAs are very rarely found in patients with HCM, but they are associated with high risk for arrhythmic sudden death and thromboembolic events. While the electrophysiologic substrate in HCM is usually located in mid-myocardium and epicardium, a large majority of sustained monomorphic VT originating at the AA was ablatable from the endocardium. The high success rate for ablation of VTs originating from the LV AA should prompt early consideration of radiofrequency ablation in this HCM subset.

Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Vascular Medicine, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, Acute Heart Failure

Keywords: Aneurysm, Arrhythmias, Cardiac, Cardiomyopathy, Hypertrophic, Catheter Ablation, Death, Sudden, Endocardium, Heart Defects, Congenital, Heart Failure, Myocardium, Pericardium, Tachycardia, Ventricular


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