Catheter ablation of refractory ventricular fibrillation storm after myocardial infarction : a multicenter study

Result code in IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00023001%3A_____%2F19%3A00078036" target="_blank" >RIV/00023001:_____/19:00078036 - isvavai.cz</a>

Result on the web

<a href="https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.118.037997" target="_blank" >https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.118.037997</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1161/CIRCULATIONAHA.118.037997" target="_blank" >10.1161/CIRCULATIONAHA.118.037997</a>

Result language

angličtina

Original language name

Catheter ablation of refractory ventricular fibrillation storm after myocardial infarction : a multicenter study

Original language description

BACKGROUND: Ventricular fibrillation (VF) storm after myocardial infarction (MI) is a life-threatening condition that necessitates multiple defibrillations. Catheter ablation is a potentially effective treatment strategy for VF storm refractory to optimal medical treatment. However, its impact on patient survival has not been verified in a large population. METHODS: We conducted a multicenter, retrospective observational study involving consecutive patients who underwent catheter ablation of post-MI refractory VF storm without preceding monomorphic ventricular tachycardia. The target of ablation was the Purkinje-related ventricular extrasystoles triggering VF. The primary outcome was in-hospital and long-term mortalities. Univariate logistic regression and Cox proportional-hazards analysis were used to evaluate clinical characteristics associated with in-hospital and longterm mortalities, respectively. RESULTS: One hundred ten patients were enrolled (age, 65 +/- 11years; 92 men; left ventricular ejection fraction, 31 +/- 10%). VF storm occurred at the acute phase of MI (4.5 +/- 2.5 days after the onset of MI during the index hospitalization for MI) in 43 patients (39%), the subacute phase (&gt; 1 week) in 48 (44%), and the remote phase (&gt; 6 months) in 19 (17%). The focal triggers were found to originate from the scar border zone in 88 patients (80%). During in-hospital stay after ablation, VF storm subsided in 92 patients (84%). Overall, 30 (27%) in-hospital deaths occurred. The duration from the VF occurrence to the ablation procedure was associated with in-hospital mortality (odds ratio for each 1-day increase, 1.11 [ 95% CI, 1.03-1.20]; P= 0.008). During follow-up after discharge from hospital, only 1 patient developed recurrent VF storm. However, 29 patients (36%) died, with a median survival time of 2.2 years (interquartile range, 1.2-5.5 years). Long-term mortality was associated with left ventricular ejection fraction &lt; 30% (hazard ratio, 2.54 [ 95% CI, 1.21-5.32]; P= 0.014), New York Heart Association class = III (hazard ratio, 2.68 [ 95% CI, 1.16-6.19]; P= 0.021), a history of atrial fibrillation (hazard ratio, 3.89 [ 95% CI, 1.42-10.67]; P= 0.008), and chronic kidney disease (hazard ratio, 2.74 [ 95% CI, 1.156.49]; P= 0.023). CONCLUSIONS: In patients with MI presenting with focally triggered VF storm, catheter ablation of culprit triggers is lifesaving and appears to be associated with short-and long-term freedom from recurrent VF storm. Mortality over the long-term follow-up is associated with the severity of underlying cardiovascular disease and comorbidities in this specific patient population.

Czech name

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Czech description

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Type

J_imp - Article in a specialist periodical, which is included in the Web of Science database

CEP classification

—

OECD FORD branch

30201 - Cardiac and Cardiovascular systems

Project

—

Continuities

N - Vyzkumna aktivita podporovana z neverejnych zdroju

Publication year

2019

Confidentiality

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Name of the periodical

Circulation

ISSN

0009-7322

e-ISSN

—

Volume of the periodical

139

Issue of the periodical within the volume

20

Country of publishing house

US - UNITED STATES

Number of pages

11

Pages from-to

2315-2325

UT code for WoS article

000468397500010

EID of the result in the Scopus database

2-s2.0-85066160277