Efficacy and safety of combined endocardial/epicardial catheter ablation for ventricular tachycardia in Chagas disease: A randomized controlled study.
Heart Rhythm
; 17(9): 1510-1518, 2020 09.
Article
em En
| MEDLINE
| ID: mdl-32087356
ABSTRACT
BACKGROUND:
Epicardial mapping and ablation are frequently necessary to eliminate ventricular tachycardia (VT) in patients with Chagas disease. Nonetheless, there are no randomized controlled trials demonstrating the role of this strategy.OBJECTIVE:
We conducted this randomized controlled trial to evaluate the efficacy and safety of combined epicardial ablation in patients with Chagas disease.METHODS:
We randomized patients with Chagas disease and VT in a 11 fashion to either the endocardial (endo) mapping and ablation group or the combined endocardial/epicardial (endo/epi) mapping and ablation group. The efficacy end points were measured by VT inducibility and all-ventricular arrhythmia recurrence. Safety was assessed by the rate of periprocedural complications.RESULTS:
Thirty patients were enrolled, and most were male. The median age was 67 (Q1 58; Q3 70) years in the endo group and 58 (Q1 43; Q3 66) years in the endo/epi group. The left ventricular ejection fraction was 33.0% ± 9.5% and 35.2% ± 11.5%, respectively P = .13. Acute success (non-reinducibility of clinical VT) was obtained in 13 patients (86%) in the endo/epi group and in 6 patients (40%) in the endo-only group (P = .021). There were 12 patients with VT recurrence (80%) in the endo-only group and 6 patients (40%) in the endo/epi group (P = .02) (by intention-to-treat analysis). Epicardial ablation was ultimately performed in 9 patients (60%) in the endo-only group because of an absence of endocardial scar or maintenance of VT inducibility. There was no difference in complications between the groups.CONCLUSION:
Combining endo/epi VT catheter ablation in patients with Chagas disease significantly increases short- and long-term freedom from all-ventricular arrhythmias. Epicardial access did not increase periprocedural complication rates.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Pericárdio
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Função Ventricular Esquerda
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Doença de Chagas
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Taquicardia Ventricular
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Ablação por Cateter
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Endocárdio
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Sistema de Condução Cardíaco
Tipo de estudo:
Clinical_trials
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Etiology_studies
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Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article