title: Catheter ablation of ventricular tachycardia after left ventricular reconstructive surgery for ischemic cardiomyopathy.
abstract: BACKGROUND
  After surgical ventricular restoration (SVR) for ischemic cardiomyopathy, ventricular tachycardias (VTs) are an important reason for postoperative morbidity and mortality.
  
  
  OBJECTIVE
  The purpose of this study was to elucidate the VT substrate, VT characteristics, and outcome of radiofrequency catheter ablation (RFCA) in patients with VT after SVR.
  
  
  METHODS
  Twelve (3%) of 416 patients referred for RFCA for VT after myocardial infarction in three centers had undergone SVR. After induction of VT, left ventricular (LV) electroanatomical mapping was performed. Ablation target sites were identified by entrainment, substrate, and/or pace mapping.
  
  
  RESULTS
  Four (33%) patients presented within the perioperative period with incessant VT, and eight (67%) presented with incessant or recurrent VT late after SVR (VT cycle length 453 ± 102 ms). The region of surgical scar was identified by electroanatomical mapping in 11 patients. Twenty-eight VTs (cycle length 384 ± 95 ms) were induced. The VT exit was bordering the surgical scar in 20 (71%) VTs, of which 15 were at the septal side. All VTs were abolished in five patients: in four only the clinical VTs were abolished, and in one reinducibility was not tested. In two patients, ablation failed after which surgical ablation was performed successfully. During follow-up, three (25%) patients died (nonarrhythmic deaths); all had presented early after SVR. Two (17%) experienced recurrent VT.
  
  
  CONCLUSIONS
  VT after LV SVR seems to have a bimodal presentation; one-third presented with incessant VT in the acute postoperative phase and had a high mortality. Two-thirds presented late after SVR; in these patients RFCA is usually effective. Successful ablation sites are frequently located at the border of surgical scars and patch material.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Adrianus P
authors.initials: AP
authors.lastname: Wijnmaalen
authors.forename: Kurt C
authors.initials: KC
authors.lastname: Roberts-Thomson
authors.forename: Daniel
authors.initials: D
authors.lastname: Steven
authors.forename: Robert J M
authors.initials: RJ
authors.lastname: Klautz
authors.forename: Stephan
authors.initials: S
authors.lastname: Willems
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: William G
authors.initials: WG
authors.lastname: Stevenson
authors.forename: Katja
authors.initials: K
authors.lastname: Zeppenfeld
mesh_terms: D000368:Aged; D018780:Body Surface Potential Mapping; D009202:Cardiomyopathies / Q000209:etiology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D011183:Postoperative Complications / Q000601:surgery*; D019651:Plastic Surgery Procedures; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome