Abstract
Objectives
This study analyzes the incidence, characteristics, and ECG morphology of ventricular tachycardia (VT) in post-infarction patients undergoing epicardial VT ablation.
Background
Ablation of recurrent VTs in patients with ischemic cardiomyopathy is typically performed endocardially. In rare cases, epicardial access is required to achieve non-inducibility.
Methods and results
The study evaluated the baseline characteristics, procedural data, and ECG morphology of clinical VT in patients undergoing epicardial VT ablation. From the initial 491 patients with coronary heart disease (CHD) and recurrent VTs undergoing ablation at the Heart Center of Leipzig, Germany, between 2012 and 2020, only 39 patients required an additional epicardial access. In 17 patients, the VTs were associated with infarction scar, while the remaining patients had concomitant CHD without infarction-associated scar and were excluded from the analysis. A propensity match study was performed at a 1:2 ratio for these 17 patients, with 34 patients of the initial cohort as a control group to evaluate the differences in baseline characteristics, procedural data, and ECG morphology of the VTs. The specific VT morphology of negative concordance and superior axis in patients with inferior scar as well as the history of VT ablation were independent predictors of the need for epicardial access.
Conclusions
In addition to previous endocardial ablation, VT ECG morphology with negative concordance and superior axis in post-infarction patients with inferior scar predicted the need for epicardial VT ablation.
Zusammenfassung
Zielsetzung
In dieser Studie analysieren wir die Inzidenz, die Charakteristika und die EKG-Morphologie ventrikulärer Tachykardien (VT) bei Postinfarktpatienten, die sich einer epikardialen VT-Ablation unterziehen.
Hintergrund
Die Ablation von rezidivierenden VTs bei Patienten mit ischämischer Kardiomyopathie wird in der Regel endokardial durchgeführt. In seltenen Fällen ist ein epikardialer Zugang erforderlich, um eine nicht-Induzierbarkeit zu erreichen.
Methoden und Ergebnisse
In der Studie wurden die Ausgangscharakteristika, die Verfahrensdaten und die EKG-Morphologie der klinischen VT bei Patienten ausgewertet, die sich einer epikardialen VT-Ablation unterzogen. Von den ursprünglich 491 Patienten mit koronarer Herzkrankheit (KHK) und rezidivierenden VTs, die sich zwischen 2012 und 2020 einer Ablation im Herzzentrum Leipzig unterzogen, benötigten nur 39 Patienten einen zusätzlichen epikardialen Zugang. Bei siebzehn Patienten waren die VTs mit einer Infarktnarbe assoziiert, während die übrigen Patienten eine begleitende KHK ohne Infarktnarbe aufwiesen und aus der Analyse ausgeschlossen wurden. Wir führten eine Propensity-Match-Studie im Verhältnis 1:2 für diese siebzehn Patienten mit 34 Patienten der ursprünglichen Kohorte als Kontrollgruppe durch, um die Unterschiede bei den Ausgangscharakteristika, den Verfahrensdaten und der EKG-Morphologie der VTs zu bewerten. Die spezifische Morphologie der VT mit negativer Konkordanz und superiorer Achse bei Patienten mit inferiorer Narbe sowie die Vorgeschichte der VT-Ablation waren unabhängige Prädiktoren für die Notwendigkeit eines epikardialen Zugangs.
Schlussfolgerungen
Neben einer vorangegangenen endokardialen Ablation war die EKG-Morphologie der VT mit negativer Konkordanz und superiorer Achse bei Postinfarktpatienten mit inferiorer Narbe ein Prädiktor für die Notwendigkeit einer epikardialen VT-Ablation.
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Abbreviations
- CABG:
-
Coronary artery bypass grafting
- CHD:
-
Coronary heart disease
- CI:
-
Confidence interval
- ECG:
-
Electrocardiogram
- NYHA:
-
New York Heart Association
- LA:
-
Left atrium
- LV-EDV:
-
Left-ventricular end-diastolic volume
- LV-EF:
-
Left-ventricular ejection fraction
- OR:
-
Odds ratio
- PCI:
-
Percutaneous coronary intervention
- VT:
-
Ventricular tachycardia
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A. Darma, L. Bertagnolli, B. Dinov, F. Torri, N. Dagres, A. Bollmann, G. Hindricks, and A. Arya declare that they have no competing interests.
For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.
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The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Darma, A., Bertagnolli, L., Dinov, B. et al. A novel ECG finding in patients with epicardial infarct-associated ventricular tachycardia: a case series. Herzschr Elektrophys 33, 217–223 (2022). https://doi.org/10.1007/s00399-022-00849-9
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DOI: https://doi.org/10.1007/s00399-022-00849-9
Keywords
- VT in post-infarction patients
- Epicardial ablation
- Inferior scar
- ECG morphology in VT
- Calcification postinfarct