RV Mapping and Ablation for VT in Postinfarction Patients
- Post-myocardial infarction (PMI) arrhythmogenic substrate can involve the RV septum and the RV free wall.
- Post ablation, patients with PMI VT involving the RV free wall have better outcomes compared with those with PMI VT involving the RV septum.
- Extensive biventricular mapping including RV mapping may be required especially if VTs cannot be eliminated by LV mapping and ablation alone.
What are the characteristics and outcomes of patients undergoing post-myocardial infarction (PMI) ventricular tachycardia (VT) ablation who have target sites in the right ventricle (RV), and what are the characteristics between patients with free wall versus septal RV target sites?
The investigators analyzed consecutive patients undergoing ablation for PMI VT with target sites located within the RV. Patients were stratified based on the presence of free wall versus septal RV target sites. Survival curves were created to evaluate the association between the two groups and freedom from death, recurrent VT, or cardiac transplantation and were compared using the log-rank test.
Among 277 consecutive patients undergoing PMI VT ablation, 30 (11%) had RV target sites (mean age 68.71 ± 9.5 years, 29 men [97%], mean left ventricular ejection fraction [LVEF] 28.70% ± 16.7%). Twenty patients had only septal VTs, and 10 patients had only free wall VTs. Fifty-seven VTs with RV targets (1.9 ± 1.4 per patient, mean cycle length 338 ± 90 ms, 53 left bundle branch, 36 superior axis) were induced. Patients with RV free wall VTs had greater rates of RV dysfunction (80% vs. 30%; p = 0.023) but had greater LVEFs (38.3% ± 21.06% vs. 23.9% ± 11.93%; p = 0.02). Over a mean follow-up period of 3.4 ± 3.2 years, patients with RV septal target sites had worse survival free of VT, transplantation, or left ventricular assist device placement after ablation (log-rank p < 0.05).
The authors report that the arrhythmogenic substrate in PMI patients often involves the RV, including the septum and free wall.
This study reports that the PMI arrhythmogenic substrate can involve the RV septum and the RV free wall by extending contiguously from the interventricular septum, giving rise to re-entry circuits in the lateral RV free wall. Of note, patients with free wall VTs were more likely to demonstrate RV dysfunction and dilation than those with exclusively septal VTs. Furthermore, post ablation, patients with PMI VT involving the RV free wall have better outcomes compared with those with PMI VT involving the RV septum. Overall, these observations suggest that extensive RV mapping may be required, especially if VTs cannot be eliminated by LV mapping and ablation alone.
Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Cardiac Surgery, Cardiovascular Care Team, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Heart Transplant, Mechanical Circulatory Support, Interventions and ACS
Keywords: Ablation Techniques, Acute Coronary Syndrome, Arrhythmias, Cardiac, Dilatation, Geriatrics, Heart-Assist Devices, Heart Failure, Heart Transplantation, Myocardial Infarction, Myocardial Ischemia, Radiofrequency Ablation, Secondary Prevention, Stroke Volume, Tachycardia, Ventricular, Ventricular Dysfunction, Right
< Back to Listings