Long-term outcome of surgical cryoablation for refractory ventricular tachycardia in patients with non-ischemic cardiomyopathy
Limited data exist on the long-term outcome of patients (pts) with non-ischemic cardiomyopathy (NICM) and ventricular tachycardia (VT) refractory to conventional therapies undergoing surgical ablation (SA). We aimed to investigate the long-term survival and VT recurrence in NICM pts with VT refracto...
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creator | Liang, Jackson J Betensky, Brian P Muser, Daniele Zado, Erica S Anter, Elad Desai, Nimesh D Callans, David J Deo, Rajat Frankel, David S Hutchinson, Mathew D Lin, David Riley, Michael P Schaller, Robert D Supple, Gregory E Santangeli, Pasquale Acker, Michael A Bavaria, Joseph E Szeto, Wilson Y Vallabhajosyula, Prashanth Marchlinski, Francis E Dixit, Sanjay |
description | Limited data exist on the long-term outcome of patients (pts) with non-ischemic cardiomyopathy (NICM) and ventricular tachycardia (VT) refractory to conventional therapies undergoing surgical ablation (SA). We aimed to investigate the long-term survival and VT recurrence in NICM pts with VT refractory to radiofrequency catheter ablation (RFCA) who underwent SA.
Consecutive pts with NICM and VT refractory to RFCA who underwent SA were included. VT substrate was characterized in the electrophysiology lab and targeted by RFCA. During SA, previous RFCA lesions/scars were identified and targeted with cryoablation (CA; 3 min/lesion; target -150 °C). Follow-up comprised office visits, ICD interrogations and the social security death index. Twenty consecutive patients with NICM who underwent SA (age 53 ± 16 years, 18 males, LVEF 41 ± 20%; dilated CM = 9, arrhythmogenic right ventricular CM = 3, hypertrophic CM = 2, valvular CM = 4, and mixed CM = 2) were studied. Percutaneous mapping/ablation in the electrophysiology lab was performed in 18 and 2 pts had primary SA. During surgery, 4.9 ± 4.0 CA lesions/pt were delivered to the endocardium (2) and epicardium (11) or both (7). VT-free survival was 72.5% at 1 year and over 43 ± 31 months (mos) (range 1-83mos), there was only one arrhythmia-related death. There was a significant reduction in ICD shocks in the 3-mos preceding SA vs. the entire follow-up period (6.6 ± 4.9 vs. 2.3 ± 4.3 shocks/pt, P = 0.001).
In select pts with NICM and VT refractory to RFCA, SA guided by pre-operative electrophysiological mapping and ablation may be a therapeutic option. |
doi_str_mv | 10.1093/europace/eux029 |
format | Article |
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Consecutive pts with NICM and VT refractory to RFCA who underwent SA were included. VT substrate was characterized in the electrophysiology lab and targeted by RFCA. During SA, previous RFCA lesions/scars were identified and targeted with cryoablation (CA; 3 min/lesion; target -150 °C). Follow-up comprised office visits, ICD interrogations and the social security death index. Twenty consecutive patients with NICM who underwent SA (age 53 ± 16 years, 18 males, LVEF 41 ± 20%; dilated CM = 9, arrhythmogenic right ventricular CM = 3, hypertrophic CM = 2, valvular CM = 4, and mixed CM = 2) were studied. Percutaneous mapping/ablation in the electrophysiology lab was performed in 18 and 2 pts had primary SA. During surgery, 4.9 ± 4.0 CA lesions/pt were delivered to the endocardium (2) and epicardium (11) or both (7). VT-free survival was 72.5% at 1 year and over 43 ± 31 months (mos) (range 1-83mos), there was only one arrhythmia-related death. There was a significant reduction in ICD shocks in the 3-mos preceding SA vs. the entire follow-up period (6.6 ± 4.9 vs. 2.3 ± 4.3 shocks/pt, P = 0.001).
In select pts with NICM and VT refractory to RFCA, SA guided by pre-operative electrophysiological mapping and ablation may be a therapeutic option.</description><identifier>ISSN: 1099-5129</identifier><identifier>EISSN: 1532-2092</identifier><identifier>DOI: 10.1093/europace/eux029</identifier><identifier>PMID: 28402404</identifier><language>eng</language><publisher>England</publisher><subject>Action Potentials ; Adult ; Aged ; Cardiomyopathies - complications ; Cardiomyopathies - mortality ; Cardiomyopathies - physiopathology ; Coronary Angiography ; Cryosurgery - adverse effects ; Cryosurgery - mortality ; Electrophysiologic Techniques, Cardiac ; Feasibility Studies ; Female ; Heart Rate ; Humans ; Male ; Middle Aged ; Recurrence ; Registries ; Retrospective Studies ; Risk Factors ; Tachycardia, Ventricular - etiology ; Tachycardia, Ventricular - mortality ; Tachycardia, Ventricular - physiopathology ; Tachycardia, Ventricular - surgery ; Time Factors ; Treatment Outcome</subject><ispartof>Europace (London, England), 2018-03, Vol.20 (3), p.e30-e41</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c338t-4393b4773a4b0cbc1f262f7ac5befdfc3fce661bfbb256e3d1d2850e26f8346f3</citedby><cites>FETCH-LOGICAL-c338t-4393b4773a4b0cbc1f262f7ac5befdfc3fce661bfbb256e3d1d2850e26f8346f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28402404$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Liang, Jackson J</creatorcontrib><creatorcontrib>Betensky, Brian P</creatorcontrib><creatorcontrib>Muser, Daniele</creatorcontrib><creatorcontrib>Zado, Erica S</creatorcontrib><creatorcontrib>Anter, Elad</creatorcontrib><creatorcontrib>Desai, Nimesh D</creatorcontrib><creatorcontrib>Callans, David J</creatorcontrib><creatorcontrib>Deo, Rajat</creatorcontrib><creatorcontrib>Frankel, David S</creatorcontrib><creatorcontrib>Hutchinson, Mathew D</creatorcontrib><creatorcontrib>Lin, David</creatorcontrib><creatorcontrib>Riley, Michael P</creatorcontrib><creatorcontrib>Schaller, Robert D</creatorcontrib><creatorcontrib>Supple, Gregory E</creatorcontrib><creatorcontrib>Santangeli, Pasquale</creatorcontrib><creatorcontrib>Acker, Michael A</creatorcontrib><creatorcontrib>Bavaria, Joseph E</creatorcontrib><creatorcontrib>Szeto, Wilson Y</creatorcontrib><creatorcontrib>Vallabhajosyula, Prashanth</creatorcontrib><creatorcontrib>Marchlinski, Francis E</creatorcontrib><creatorcontrib>Dixit, Sanjay</creatorcontrib><title>Long-term outcome of surgical cryoablation for refractory ventricular tachycardia in patients with non-ischemic cardiomyopathy</title><title>Europace (London, England)</title><addtitle>Europace</addtitle><description>Limited data exist on the long-term outcome of patients (pts) with non-ischemic cardiomyopathy (NICM) and ventricular tachycardia (VT) refractory to conventional therapies undergoing surgical ablation (SA). We aimed to investigate the long-term survival and VT recurrence in NICM pts with VT refractory to radiofrequency catheter ablation (RFCA) who underwent SA.
Consecutive pts with NICM and VT refractory to RFCA who underwent SA were included. VT substrate was characterized in the electrophysiology lab and targeted by RFCA. During SA, previous RFCA lesions/scars were identified and targeted with cryoablation (CA; 3 min/lesion; target -150 °C). Follow-up comprised office visits, ICD interrogations and the social security death index. Twenty consecutive patients with NICM who underwent SA (age 53 ± 16 years, 18 males, LVEF 41 ± 20%; dilated CM = 9, arrhythmogenic right ventricular CM = 3, hypertrophic CM = 2, valvular CM = 4, and mixed CM = 2) were studied. Percutaneous mapping/ablation in the electrophysiology lab was performed in 18 and 2 pts had primary SA. During surgery, 4.9 ± 4.0 CA lesions/pt were delivered to the endocardium (2) and epicardium (11) or both (7). VT-free survival was 72.5% at 1 year and over 43 ± 31 months (mos) (range 1-83mos), there was only one arrhythmia-related death. There was a significant reduction in ICD shocks in the 3-mos preceding SA vs. the entire follow-up period (6.6 ± 4.9 vs. 2.3 ± 4.3 shocks/pt, P = 0.001).
In select pts with NICM and VT refractory to RFCA, SA guided by pre-operative electrophysiological mapping and ablation may be a therapeutic option.</description><subject>Action Potentials</subject><subject>Adult</subject><subject>Aged</subject><subject>Cardiomyopathies - complications</subject><subject>Cardiomyopathies - mortality</subject><subject>Cardiomyopathies - physiopathology</subject><subject>Coronary Angiography</subject><subject>Cryosurgery - adverse effects</subject><subject>Cryosurgery - mortality</subject><subject>Electrophysiologic Techniques, Cardiac</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Heart Rate</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Recurrence</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Tachycardia, Ventricular - etiology</subject><subject>Tachycardia, Ventricular - mortality</subject><subject>Tachycardia, Ventricular - physiopathology</subject><subject>Tachycardia, Ventricular - surgery</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1099-5129</issn><issn>1532-2092</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kEtPwzAQhC0EoqVw5oZ85BLqR55HVPGSKnGBc2Rv7MYoiYvtALnw2zG05bQj7cxo90PokpIbSiq-VKOzWwEqii_CqiM0pxlnCSMVO46aVFWSUVbN0Jn3b4SQglXZKZqxMiUsJekcfa_tsEmCcj22YwDbK2w19qPbGBAdBjdZITsRjB2wtg47pZ2AYN2EP9QQnIGxEw4HAe0EwjVGYDPgbQzErcefJrR4sENiPLSqN4D_TLaf4tmhnc7RiRadVxf7uUCv93cvq8dk_fzwtLpdJ8B5GZKUV1ymRcFFKglIoJrlTBcCMql0o4FrUHlOpZaSZbniDW1YmRHFcl3yNNd8ga53vVtn30flQ93Hi1TXiUHZ0de0LAuSkZTRaF3urOCs9_HfeutML9xUU1L_Qq8P0Osd9Ji42pePslfNv_9Amf8A5qaFLQ</recordid><startdate>20180301</startdate><enddate>20180301</enddate><creator>Liang, Jackson J</creator><creator>Betensky, Brian P</creator><creator>Muser, Daniele</creator><creator>Zado, Erica S</creator><creator>Anter, Elad</creator><creator>Desai, Nimesh D</creator><creator>Callans, David J</creator><creator>Deo, Rajat</creator><creator>Frankel, David S</creator><creator>Hutchinson, Mathew D</creator><creator>Lin, David</creator><creator>Riley, Michael P</creator><creator>Schaller, Robert D</creator><creator>Supple, Gregory E</creator><creator>Santangeli, Pasquale</creator><creator>Acker, Michael A</creator><creator>Bavaria, Joseph E</creator><creator>Szeto, Wilson Y</creator><creator>Vallabhajosyula, Prashanth</creator><creator>Marchlinski, Francis E</creator><creator>Dixit, Sanjay</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20180301</creationdate><title>Long-term outcome of surgical cryoablation for refractory ventricular tachycardia in patients with non-ischemic cardiomyopathy</title><author>Liang, Jackson J ; Betensky, Brian P ; Muser, Daniele ; Zado, Erica S ; Anter, Elad ; Desai, Nimesh D ; Callans, David J ; Deo, Rajat ; Frankel, David S ; Hutchinson, Mathew D ; Lin, David ; Riley, Michael P ; Schaller, Robert D ; Supple, Gregory E ; Santangeli, Pasquale ; Acker, Michael A ; Bavaria, Joseph E ; Szeto, Wilson Y ; Vallabhajosyula, Prashanth ; Marchlinski, Francis E ; Dixit, Sanjay</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c338t-4393b4773a4b0cbc1f262f7ac5befdfc3fce661bfbb256e3d1d2850e26f8346f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Action Potentials</topic><topic>Adult</topic><topic>Aged</topic><topic>Cardiomyopathies - complications</topic><topic>Cardiomyopathies - mortality</topic><topic>Cardiomyopathies - physiopathology</topic><topic>Coronary Angiography</topic><topic>Cryosurgery - adverse effects</topic><topic>Cryosurgery - mortality</topic><topic>Electrophysiologic Techniques, Cardiac</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Heart Rate</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Recurrence</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Tachycardia, Ventricular - etiology</topic><topic>Tachycardia, Ventricular - mortality</topic><topic>Tachycardia, Ventricular - physiopathology</topic><topic>Tachycardia, Ventricular - surgery</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Liang, Jackson J</creatorcontrib><creatorcontrib>Betensky, Brian P</creatorcontrib><creatorcontrib>Muser, Daniele</creatorcontrib><creatorcontrib>Zado, Erica S</creatorcontrib><creatorcontrib>Anter, Elad</creatorcontrib><creatorcontrib>Desai, Nimesh D</creatorcontrib><creatorcontrib>Callans, David J</creatorcontrib><creatorcontrib>Deo, Rajat</creatorcontrib><creatorcontrib>Frankel, David S</creatorcontrib><creatorcontrib>Hutchinson, Mathew D</creatorcontrib><creatorcontrib>Lin, David</creatorcontrib><creatorcontrib>Riley, Michael P</creatorcontrib><creatorcontrib>Schaller, Robert D</creatorcontrib><creatorcontrib>Supple, Gregory E</creatorcontrib><creatorcontrib>Santangeli, Pasquale</creatorcontrib><creatorcontrib>Acker, Michael A</creatorcontrib><creatorcontrib>Bavaria, Joseph E</creatorcontrib><creatorcontrib>Szeto, Wilson Y</creatorcontrib><creatorcontrib>Vallabhajosyula, Prashanth</creatorcontrib><creatorcontrib>Marchlinski, Francis E</creatorcontrib><creatorcontrib>Dixit, Sanjay</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Europace (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Liang, Jackson J</au><au>Betensky, Brian P</au><au>Muser, Daniele</au><au>Zado, Erica S</au><au>Anter, Elad</au><au>Desai, Nimesh D</au><au>Callans, David J</au><au>Deo, Rajat</au><au>Frankel, David S</au><au>Hutchinson, Mathew D</au><au>Lin, David</au><au>Riley, Michael P</au><au>Schaller, Robert D</au><au>Supple, Gregory E</au><au>Santangeli, Pasquale</au><au>Acker, Michael A</au><au>Bavaria, Joseph E</au><au>Szeto, Wilson Y</au><au>Vallabhajosyula, Prashanth</au><au>Marchlinski, Francis E</au><au>Dixit, Sanjay</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-term outcome of surgical cryoablation for refractory ventricular tachycardia in patients with non-ischemic cardiomyopathy</atitle><jtitle>Europace (London, England)</jtitle><addtitle>Europace</addtitle><date>2018-03-01</date><risdate>2018</risdate><volume>20</volume><issue>3</issue><spage>e30</spage><epage>e41</epage><pages>e30-e41</pages><issn>1099-5129</issn><eissn>1532-2092</eissn><abstract>Limited data exist on the long-term outcome of patients (pts) with non-ischemic cardiomyopathy (NICM) and ventricular tachycardia (VT) refractory to conventional therapies undergoing surgical ablation (SA). We aimed to investigate the long-term survival and VT recurrence in NICM pts with VT refractory to radiofrequency catheter ablation (RFCA) who underwent SA.
Consecutive pts with NICM and VT refractory to RFCA who underwent SA were included. VT substrate was characterized in the electrophysiology lab and targeted by RFCA. During SA, previous RFCA lesions/scars were identified and targeted with cryoablation (CA; 3 min/lesion; target -150 °C). Follow-up comprised office visits, ICD interrogations and the social security death index. Twenty consecutive patients with NICM who underwent SA (age 53 ± 16 years, 18 males, LVEF 41 ± 20%; dilated CM = 9, arrhythmogenic right ventricular CM = 3, hypertrophic CM = 2, valvular CM = 4, and mixed CM = 2) were studied. Percutaneous mapping/ablation in the electrophysiology lab was performed in 18 and 2 pts had primary SA. During surgery, 4.9 ± 4.0 CA lesions/pt were delivered to the endocardium (2) and epicardium (11) or both (7). VT-free survival was 72.5% at 1 year and over 43 ± 31 months (mos) (range 1-83mos), there was only one arrhythmia-related death. There was a significant reduction in ICD shocks in the 3-mos preceding SA vs. the entire follow-up period (6.6 ± 4.9 vs. 2.3 ± 4.3 shocks/pt, P = 0.001).
In select pts with NICM and VT refractory to RFCA, SA guided by pre-operative electrophysiological mapping and ablation may be a therapeutic option.</abstract><cop>England</cop><pmid>28402404</pmid><doi>10.1093/europace/eux029</doi><oa>free_for_read</oa></addata></record> |
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source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Oxford Journals Open Access Collection; PubMed Central; Alma/SFX Local Collection |
subjects | Action Potentials Adult Aged Cardiomyopathies - complications Cardiomyopathies - mortality Cardiomyopathies - physiopathology Coronary Angiography Cryosurgery - adverse effects Cryosurgery - mortality Electrophysiologic Techniques, Cardiac Feasibility Studies Female Heart Rate Humans Male Middle Aged Recurrence Registries Retrospective Studies Risk Factors Tachycardia, Ventricular - etiology Tachycardia, Ventricular - mortality Tachycardia, Ventricular - physiopathology Tachycardia, Ventricular - surgery Time Factors Treatment Outcome |
title | Long-term outcome of surgical cryoablation for refractory ventricular tachycardia in patients with non-ischemic cardiomyopathy |
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