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European Heart Journal 2004 25(13):1127-1138; doi:10.1016/j.ehj.2004.01.021
Copyright © 2004 by the European Society of Cardiology.
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Clinical research

Incidence and significance of pleomorphism in patients with postmyocardial infarction ventricular tachycardia

Acute and long-term outcome of radiofrequency catheter ablation

Paolo Della Bellaa,*, Stefania Rivaa, Gaetano Fassinia, Francesco Giraldia, Marco Bertia, Catherine Klersyb and Nicola Trevisia

a Arrhythmia Department, Centro Cardiologico Monzino, Institute of Cardiology, University of Milan, Via Parea 4, Milan 20138, Italy
b Biometry and Clinical Epidemiology, Research Department, IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy

* Corresponding author. Tel.: +39-2-580021/58002340/58002275; fax: +39-2-504-667
E-mail address: pdellabella{at}cardiologicomonzino.it

Received 14 February 2003; revised 15 January 2004; accepted 22 January 2004

Abstract

Aims The prognostic significance of multiple ventricular tachycardia (VT) morphologies, whether spontaneous or induced, was investigated in patients who underwent radiofrequency catheter ablation (RFCA) for postinfarction ventricular tachycardia.

Methods and results We studied 137 patients with postinfarction ventricular tachycardia. Catheter ablation of all induced ventricular tachycardias was attempted.

A single ventricular tachycardia morphology was documented in 102/137 patients (MONO group); 35 patients had spontaneous pleomorphism (PLEO group). Multiple VT morphologies were induced in 58/102 (57%) MONO patients and in all PLEO patients. A higher rate of arrhythmia suppression was obtained in MONO as compared to PLEO patients (162/212 [76%] vs. 43/110 [39%]). Clinical presentation (VT pleomorphism) (OR: 0.22, CI: 0.08–0.62) and the induced VT cycle (mean PLEO/MONO: 338/385 ms, OR: 1.06) were independent predictors of acute RFCA success. Among MONO patients, the procedure was successful in 75% of the patients with a single induced ventricular tachycardia compared to 64% of those with multiple tachycardias. The acute success rate was lower in PLEO patients (23%). PLEO patients had a significantly higher 3- and 5-year arrhythmia recurrence rate than MONO patients. RFCA acute success was the only independent predictor of long-term outcome in multivariate analysis.

Conclusions Spontaneous, but not induced, VT pleomorphism in patients with prior myocardial infarction adversely affects the acute and long-term success rate of RFCA.

Key Words: Ventricular tachycardia • Catheter ablation


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