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

Kód výsledku v 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>

Výsledek na webu

<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>

Jazyk výsledku

angličtina

Název v původním jazyce

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

Popis výsledku v původním jazyce

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.

Název v anglickém jazyce

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

Popis výsledku anglicky

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.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30201 - Cardiac and Cardiovascular systems

Projekt

—

Návaznosti

N - Vyzkumna aktivita podporovana z neverejnych zdroju

Rok uplatnění

2019

Kód důvěrnosti údajů

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

Název periodika

Circulation

ISSN

0009-7322

e-ISSN

—

Svazek periodika

139

Číslo periodika v rámci svazku

20

Stát vydavatele periodika

US - Spojené státy americké

Počet stran výsledku

11

Strana od-do

2315-2325

Kód UT WoS článku

000468397500010

EID výsledku v databázi Scopus

2-s2.0-85066160277