Author + information
- Received July 22, 2019
- Revision received September 13, 2019
- Accepted September 18, 2019
- Published online December 18, 2019.
- Yasuhiro Shirai, MDa,b,
- Jackson J. Liang, DOa,
- Kenzo Hirao, MDb,
- Matthew C. Hyman, MD, PhDa,
- Ramanan Kumareswaran, MDa,
- Jeffrey S. Arkles, MDa,
- Robert D. Schaller, DOa,
- Gregory E. Supple, MDa,
- David S. Frankel, MDa,
- Saman Nazarian, MD, PhDa,
- Michael P. Riley, MD, PhDa,
- Fermin C. Garcia, MDa,
- David Lin, MDa,
- Sanjay Dixit, MDa,
- David J. Callans, MDa,
- Francis E. Marchlinski, MDa and
- Pasquale Santangeli, MD, PhDa,∗ ()
- aElectrophysiology Section, Cardiovascular, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- bDepartment of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
- ↵∗Address for correspondence:
Dr. Pasquale Santangeli, Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pennsylvania 19104.
Objectives This study sought to evaluate the prevalence, mapping features, and ablation outcomes of non–scar-related ventricular tachycardia (NonScar-VT) and Purkinje-related VT (Purkinje-VT) in patients with structural heart disease.
Background VT in structural heart disease is typically associated with scar-related myocardial re-entry. NonScar-VTs arising from areas of normal myocardium or Purkinje-VTs originating from the conduction system are less common.
Methods We retrospectively analyzed 690 patients with structural heart disease who underwent VT ablation between 2013 and 2017.
Results A total of 37 (5.4%) patients (16 [43%] with ischemic cardiomyopathy, 16 [43%] with nonischemic dilated cardiomyopathy, and 5 [14%] others) demonstrated NonScar/Purkinje-VTs, which represented the clinical VT in 76% of cases. Among the 37 VTs, 31 (84%) were Purkinje-VTs (28 bundle branch re-entrant VT). The remaining 6 (16%) VTs were NonScar-VTs and included 4 idiopathic outflow tract VTs. A total of 16 patients had prior history of VT ablations: empirical scar substrate modification was performed in 6 (38%) patients and residual inducibility of VT had not been assessed in 7 (44%). In all 37 patients, the NonScar/Purkinje-VT was successfully ablated. After a median follow-up of 18 months, the targeted NonScar/Purkinje-VT did not recur in any patients, and 28 (76%) of patients were free from any recurrent VT episodes.
Conclusions NonScar/Purkinje-VTs can be identified in 5.4% of patients undergoing VT ablation in the setting of structural heart disease. Careful effort to induce, characterize, and map these VTs is important because substrate-based ablation strategies would fail to eliminate these types of VT.
Dr. Nazarian was supported by National Institutes of Health/National Heart, Lung, and Blood Institute grants R01HL116280 and R01HL14289. Dr. Kumareswaran has served as a consultant for Medtronic. Dr. Nazarian has received research grant support from Biosense Webster, Siemens, and ImriCor; and served as a consultant for Circle Software and CardioSolv. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The 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 July 22, 2019.
- Revision received September 13, 2019.
- Accepted September 18, 2019.
- 2019 American College of Cardiology Foundation
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