Ventricular tachycardia associated with morphologic substrate: radiofrequency catheter ablation or cardiac surgery?

Introduction: Ventricular tachycardia (VT) with morphologic underlying substrate (aneurysm, post myocardial infarction scars, diverticulum and cardiac tumor) can benefie t from case to case of ablative techniques by radiofrequency catheter ablation (RFA) or of surgical intervention with consequent suppression of the arrhythmogenic substrate. The present study aims to compare the advantages and disadvantages of each of the methods and to facilitate the optimal choice for the patient. Methods: Between 1998 and 2014 we admitted in the IBCV Timișoara a number of 38 patients (p) with left ventricular (LV) or right ventricular (RV) arrhythmias associated with: • LV calcifi ed myocardial tumor –1 p (2.63%) • LV diverticulum – 1 p (2.63%) • LV aneurysm – 21 p (55.26%) • RV aneurysm – 6 p (15.78%) • Post infarction scar – 9 p (23.68%) All the patients were explored by standard electrophysiological study (EPS) before the RFA or surgical procedure. Th e EPS evidenced: • monomorphic VT in 18 p (47.36%) • polymorphic VT in 20 p (52.63%). In 9 patients the surgery was chosen (calcifi ed LV tumor – 1 p, LV diverticulum – 1 p, LV aneurysm – 7 p). In all others 29 p we proceeded to RFA and in 7 p the implantation of cardiac defibrillator was decided. Results: After the intervention, between one month and three months, the electrophysiological study was redone and the results were the following: • the absence of the sustained or not-sustained VT and the persistence of a ventricular extrasystolic arrhythmia with the same morphology as the previous VT; • in the radiofrequency catheter ablation group there were 15 recurrences. Th e RFA was redone in all 15 patients and the novel recurrences were present in 7 patients, who needed a defi brillator implantation. Conclusions: The study provided the following data: • The surgical method is more effi cient because the optimal removal of the entire arrhythmogenic substrate is performed; this method removes the morphopathological substrate that can be cause of heart failure or emboli. This method has the big disadvantage that is not agreed by the patient. • The ablative method can suppress the reentry circuit, but does not infl uence the morphological substrate than can develop other new circuits. Sometimes, the VT is polymorphic, the intervention prolongs, the aneurysmal sac can be predisposed to the clots formation and the risk of perforation rises. Th is method has the advantage that is agreed by the patient. We conclude that the two methods are complementary.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)