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Long term follow‐up after ventricular tachycardia ablation in patients with congenital heart disease
Author(s) -
Yang Jiandu,
Brunnquell Michael,
Liang Jackson J.,
Callans David J.,
Garcia Fermin C.,
Lin David,
Frankel David S.,
Kay Joseph,
Marchlinski Francis E.,
Tzou Wendy,
Sauer William H.,
Liu Bolun,
Ruckdeschel Emily S.,
Collins Kathryn,
Santangeli Pasquale,
Nguyen Duy T.
Publication year - 2019
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.13996
Subject(s) - medicine , ablation , ventricular tachycardia , cardiology , heart disease , ventricular outflow tract , tachycardia , complication , catheter ablation , electrophysiologic study , surgery
Background Ventricular tachycardia (VT) is frequently encountered in patients with repaired and unrepaired congenital heart disease (CHD), causing significant morbidity and sudden cardiac death. Data regarding underlying VT mechanisms and optimal ablation strategies in these patients remain limited. Objective To describe the electrophysiologic mechanisms, ablation strategies, and long‐term outcomes in patients with CHD undergoing VT ablation. Methods Forty‐eight patients (mean age 41.3 ± 13.3 years, 77.1% male) with CHD underwent a total of 57 VT ablation procedures at two centers from 2000 to 2017. Electrophysiologic and follow‐up data were analyzed. Results Of the 77 different VTs induced at initial or repeat ablation, the underlying mechanism in 62 (81.0%) was due to scar‐related re‐entry; the remaining included four His‐Purkinje system–related macrore‐entry VTs and focal VTs mainly originating from the outflow tract region (8 of 11, 72.7%). VT‐free survival after a single procedure was 72.9% (35 of 48) at a median follow‐up of 53 months. VT‐free survival after multiple procedures was 85.4% (41 of 48) at a median follow‐up of 52 months. There were no major complications. Three patients died during the follow‐up period from nonarrhythmic causes, including heart failure and cardiac surgery complication. Conclusion While scar‐related re‐entry is the most common VT mechanism in patients with CHD, importantly, nonscar‐related VT may also be present. In experienced tertiary care centers, ablation of both scar‐related and nonscar‐related VT in patients with CHD is safe, feasible, and effective over long‐term follow‐up.