Author + information
- Received April 9, 2018
- Revision received August 13, 2018
- Accepted August 14, 2018
- Published online January 21, 2019.
- Jackson J. Liang, DO,
- Simon A. Castro, MD,
- Daniele Muser, MD,
- David F. Briceno, MD,
- Yasuhiro Shirai, MD,
- Andres Enriquez, MD,
- Ramanan Kumareswaran, MD,
- Pasquale Santangeli, MD, PhD,
- Erica S. Zado, PA-C,
- Jeffrey S. Arkles, MD,
- Robert D. Schaller, DO,
- Gregory E. Supple, MD,
- David S. Frankel, MD,
- Saman Nazarian, MD, PhD,
- Michael P. Riley, MD, PhD,
- Fermin C. Garcia, MD,
- David Lin, MD,
- Sanjay Dixit, MD,
- David J. Callans, MD and
- Francis E. Marchlinski, MD∗ ()
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- ↵∗Address for correspondence:
Dr. Francis E. Marchlinski, Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, 9 Founders Pavilion, 3400 Spruce Street, Philadelphia, Pennsylvania 19104.
Objectives This study sought to investigate the substrate, procedural strategies, safety, and outcomes of catheter ablation (CA) for ventricular tachycardia (VT) in patients with aortic valve replacement (AVR).
Background VT ablation in patients with AVR is challenging, particularly when mapping and ablation in the periaortic region are necessary.
Methods We identified consecutive patients with mechanical, bioprosthetic, and transcatheter AVR who underwent CA for VT refractory to antiarrhythmic drugs and analyzed VT substrate, approach to LV access, complications, and long-term outcomes.
Results Overall, 29 patients (87% men, mean age 67.9 ± 9.8 years, left ventricular ejection fraction 39 ± 10%) with prior AVR (13 mechanical, 15 bioprosthetic, 1 transcatheter AVR) underwent 40 ablations from 2004 to 2016. Left-sided mapping/CA was performed in 27 patients (36 procedures). Access was retrograde aortic in 11 procedures (all bioprosthetic), transseptal in 24 (13 mechanical; 10 bioprosthetic; 1 transcatheter AVR), or transventricular septal in 1. Periaortic bipolar or unipolar scar was detected in all 24 patients in whom detailed periaortic mapping was performed. Clinical VT circuit(s) involved the periaortic region in 10 patients (34%), 2 (7%) had bundle branch re-entry VT, and 17 (59%) had substrate unrelated to AVR. There were 2 major complications (both related to vascular access). Only 2 patients (9.1%) had VT recurrence. Over median follow-up of 12.8 months, 11 patients died (none as a result of recurrent VT).
Conclusions Whereas most patients undergoing CA for VT after AVR had VT from substrate unrelated to AVR, periaortic scar is universally present and bundle branch re-entry can be the VT mechanism. CA can be safely performed with excellent long-term VT elimination.
Dr. Arkles provides consulting services to Biosense Webster. Dr. Nazarian provides consulting services to Siemens, Biosense Webster, and CardioSolv; and has received research grants from Biosense Webster and ImriCor. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received April 9, 2018.
- Revision received August 13, 2018.
- Accepted August 14, 2018.
- 2019 American College of Cardiology Foundation
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