Results

During the ablation procedure, VT was monomor-phic in six patients, five patients had two morphologies, four had three, and seven had from four to eight morphologies (Fig. 19.3).

Thirteen patients were successfully treated by a single session, four required two sessions, two required three sessions, and one four. However, two patients of the same cohort received eight and eleven sessions respectively, during the same study period (Fig. 19.4). They will be later referred to as Case #1 and Case #2 (Fig. 19.5).

Ablation was done only in the right ventricle in all patients. Four to 34 applications of RF energy (mean=17) were delivered as initial treatment. This approach alone proved to be successful in ten patients with "success" and three more patients with a "partial success" leading to a clinical success of 60%. F was used as secondary treatment in patients who failed from 17 to 34 RF applications. This approach was used in the nine remaining patients with the delivery of two to eight DC shocks.

Number of Morphologies

Fig.19.3 • Largest number of VT morphologies observed for each patient during the procedures

Number of Morphologies

Fig.19.3 • Largest number of VT morphologies observed for each patient during the procedures

11 Success

1

r

4 Success

22 Session I

8 Failure

J

8 Session II

4 Failure

i

r

4 Session III

r

3 Failure

3 Session IV

r

2 Failure

r

2 Session VIII

r

1 Failure

r

3 P Success

1 P Success

1 P Success

1 P Success

1 Failure

1 Surgery

1 Success

Fig. 19.4 • VT ablation in ARVC/D (including surgery) leading to a final clinical success rate of 100%.Information in the boxes indicates number of patients and outcome.The roman numerals indicate the number of sessions of ablations

3456789 10 11 Number of Sessions

Fig. 19.5 • Number of ablation sessions.The two cases requiring eight and eleven sessions are obvious outliers

Originally we changed catheters after two DC shocks. However at present, all catheters were able to withstand high-energy shocks. Repeat ablation sessions were performed during the same hospital stay in four patients (one had three sessions during the same stay). A new hospitalization was necessary in six patients needing two to ten rehospitalizations. The time interval between these sessions is presented in detail for the two cases #1 and #2 in Figs. 19.6 and 19.7.

M 15

M 15

3 4 5 6 7 Ablation Sessions in Case #1

Fig. 19.6 • Time intervals between successive ablation sessions. Numbers above the dots indicate the number of recorded VT morphologies.Numbers between brackets represent the VT rate in beats per minute. Some long intervals wrongly suggesting control of VT were probably the result of disease progression finally controlled by ablation

3 4 5 6 7 Ablation Sessions in Case #1

Fig. 19.6 • Time intervals between successive ablation sessions. Numbers above the dots indicate the number of recorded VT morphologies.Numbers between brackets represent the VT rate in beats per minute. Some long intervals wrongly suggesting control of VT were probably the result of disease progression finally controlled by ablation

Fig. 19.4 • VT ablation in ARVC/D (including surgery) leading to a final clinical success rate of 100%.Information in the boxes indicates number of patients and outcome.The roman numerals indicate the number of sessions of ablations

Surgical RF Ablation

Ablation Sessions in Case #2

Fig. 19.7 • Time intervals between successive ablation sessions. Numbers above the dots indicate the number of recorded VT morphologies.Numbers between brackets represent the VT rate in beats per minute. Some long intervals wrongly suggesting control of VT were probably the result of disease progression finally controlled by ablation.Except for session 9,where four of the five morphologies were nonclinical, all the other VTs seemed to involve the same ar-rhythmogenic substrate which was finally controlled only after surgical epicardial RF ablation

Surgical RF Ablation

Ablation Sessions in Case #2

Fig. 19.7 • Time intervals between successive ablation sessions. Numbers above the dots indicate the number of recorded VT morphologies.Numbers between brackets represent the VT rate in beats per minute. Some long intervals wrongly suggesting control of VT were probably the result of disease progression finally controlled by ablation.Except for session 9,where four of the five morphologies were nonclinical, all the other VTs seemed to involve the same ar-rhythmogenic substrate which was finally controlled only after surgical epicardial RF ablation

Patient Follow-Up After the Last Session

No patient was lost to follow-up. The mean follow-up period was 35 (±22 months, SD) ranging from 6 to 73 months.

Overall Results

VT catheter ablation failed only in one patient (Case #2) finally controlled by surgery (Fig. 19.4).

Complications

No complications were observed in this study as compared to the patients treated before 1999, during which one patient (not ARVC/D) died when a percutaneous epicardial approach was used [1].

Survival

In this series, no patient died suddenly after hospital discharge and there were no deaths due to congestive heart failure. Of note, two patients had a left ventricular ejection fraction below 45% (Fig. 19.2). This was clearly different from other patients and suggested the role of a superimposed episode of myocarditis as we have previously described [12-14].

Was this article helpful?

0 0

Post a comment