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Long-term follow-up of idiopathic ventricular fibrillation ablation: a multicenter study
Sébastien Knecht1, Frédéric Sacher, Matthew Wright
1Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France. sebastien.knecht@chu-brugmann.be
Insights
Catheter ablation effectively treats idiopathic ventricular fibrillation (VF) by targeting premature ventricular beats (VPBs). This long-term study shows ablation significantly reduces VF recurrence and improves survival-free from VF.
Area of Science:
- Electrophysiology
- Cardiology
- Medical Devices
Background:
- Idiopathic ventricular fibrillation (VF) can be life-threatening.
- Catheter ablation targeting premature ventricular beats (VPBs) shows promise for short-term VF control.
- Long-term outcomes of this ablation strategy require further evaluation.
Purpose of the Study:
- To assess the long-term efficacy of catheter ablation for idiopathic VF.
- To evaluate the recurrence rate of VF after ablation.
- To identify predictors of successful ablation and long-term freedom from VF.
Main Methods:
- A multicenter study included 38 patients with idiopathic VF.
- Ablation targeted short-coupled VPB triggers identified by activation or pace mapping.
- Patients were followed for a median of 63 months post-ablation.
Main Results:
- 18% of patients experienced VF recurrence, with most successfully retreated.
- Ablation significantly reduced the rate of major arrhythmic events (p=0.01).
- Transient bundle-branch block during electrophysiology predicted VF-free survival (p<0.0001).
Conclusions:
- Catheter ablation targeting VPB triggers is associated with long-term freedom from idiopathic VF.
- Repeat ablation is effective for managing recurrent VF post-procedure.
- This strategy offers a durable solution for patients with idiopathic VF.
Objectives:
This multicenter study sought to evaluate the long-term follow-up of patients ablated for idiopathic ventricular fibrillation (VF).
Background:
Catheter ablation of idiopathic VF that targets ventricular premature beat (VPB) triggers has been shown to prevent VF recurrences on short-term follow-up.
Methods:
From January 2000, 38 consecutive patients from 6 different centers underwent ablation of primary idiopathic VF initiated by short coupled VPB. All patients had experienced at least 1 documented VF, with 87% having experienced > or =2 VF episodes in the preceding year. Catheter ablation was guided by activation mapping of VPBs or pace mapping during sinus rhythm.
Results:
There were 38 patients (21 men) age 42 +/- 13 years, refractory to a median of 2 antiarrhythmic drugs. Triggering VPBs originated from the right (n = 16), the left (n = 14), or both (n = 3) Purkinje systems and from the myocardium (n = 5). During a median post-procedural follow-up of 63 months, 7 (18%) of 38 patients experienced VF recurrence at a median of 4 months. Five of these 7 patients underwent repeat ablation without VF recurrence. Survival free of VF was predicted only by transient bundle-branch block in the originating ventricle during the electrophysiological study (p < 0.0001). The number of significant events (confirmed VF or aborted sudden death) was reduced from 4 (interquartile range 3 to 9) before to 0 (interquartile range 0 to 4) after ablation (p = 0.01).
Conclusions:
Ablation for idiopathic VF that targets short coupled VPB triggers is associated with a long-term freedom from VF recurrence.
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