Focal ventricular tachycardias in structural heart disease: prevalence, characteristics, and clinical outcomes after catheter ablation

Robert D. Anderson, Geoffrey Lee, Ivana Trivic, Timothy Campbell, Timmy Pham, Chrishan Nalliah, Eddy Kizana, Stuart P. Thomas, Siddharth J. Trivedi, Troy Watts, Jonathan Kalman, Saurabh Kumar

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)

Abstract

OBJECTIVES: This study sought to summarize the procedural characteristics and outcomes of patients with structural heart disease (SHD) who have focal ventricular tachycardia (VT).

BACKGROUND: Scar-mediated re-entry is the predominant mechanism of VT in SHD. Some SHD patients may have a focal VT mechanism that remains poorly described.

METHODS: An extended induction protocol incorporating programmed electrical stimulation, right ventricular burst pacing and isoprenaline was used to elucidate both re-entrant and focal VT mechanisms.

RESULTS: Eighteen of 112 patients (16%) with SHD undergoing VT ablation over 2 years had a focal VT mechanism elucidated (mean age 66±13 years; ejection fraction 46±14%; nonischemic cardiomyopathy 10). Repetitive failure of termination with antitachycardia pacing (ATP) (69% of patients) or defibrillator shocks (56%) was a common feature of focal VTs. A median of 3 VTs per patient were inducible (28 focal VTs, 34 re-entrant VTs; 53% of patients had both focal and re-entrant VT mechanism). Focal VTs more commonly originated from the right ventricle (RV) than the left ventricle (LV) (67% vs. 33%, respectively). In the RV, the RV outflow tract was the most common site (33% of all focal VTs), followed by the RV moderator band (22%), apical septal RV (6%), and lateral tricuspid annulus (6%). The lateral LV (non-Purkinje) was the most common LV focal VT site (16%), followed by the papillary muscles (17%). After median follow-up of 289 days, 78% of patients remained arrhythmia-free; no patients had recurrence of focal VT at repeat procedure. In patients with recurrence, defibrillator therapies were significantly reduced from a median of 53 ATP episodes pre-ablation to 10 ATP episodes post-ablation. During follow-up, 2 patients (11%) underwent repeat VT ablation; none had recurrence of focal VT.

CONCLUSIONS: Focal VTs are common in patients with SHD and often coexist with re-entrant forms of VT. High failure rate of defibrillator therapies was a common feature of focal VT mechanisms. Uncovering and abolishing focal VT may further improve outcomes of catheter ablation in SHD.

Original languageEnglish
Pages (from-to)56-69
Number of pages14
JournalJACC: Clinical Electrophysiology
Volume6
Issue number1
DOIs
Publication statusPublished - Jan 2020
Externally publishedYes

Keywords

  • catheter ablation
  • focal ventricular tachycardia
  • scar-mediated re-entry
  • ventricular tachycardia

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