title: Drug-refractory ventricular tachycardias after myocarditis: endocardial and epicardial radiofrequency catheter ablation.
abstract: BACKGROUND
  Ventricular tachycardia (VT) is a significant therapeutic challenge in patients with myocarditis. This study aimed to assess the efficacy and safety of radiofrequency catheter ablation (RFCA) of VT in patients with myocarditis.
  
  
  RESULTS
  We enrolled 20 patients (15 men; age, 42 [28-52] years) with a history of biopsy-proven viral myocarditis and drug-refractory VT; 5 patients presented with electrical storm. The median left ventricular ejection fraction was 55% (45-60%). All patients underwent endocardial RFCA with an irrigated catheter, using contact electroanatomic mapping. Recurrence of sustained VT after endocardial RFCA was treated with additional epicardial RFCA. Endocardial RFCA was acutely successful in 14 patients (70%) while in the remaining 6 (30%) clinical VT was successfully ablated by epicardial RFCA. In 1 patient, hemodynamic instability required an intra-aortic balloon pump to complete RFCA. No major complication occurred during or after RFCA. Over a median follow-up time of 28 (11-48) months, 18 patients (90%) remained free of sustained VT; 2 patients (10%, both with baseline left ventricular ejection fraction≤35%) died of acute heart failure unrelated to ventricular arrhythmias.
  
  
  CONCLUSIONS
  In patients with myocarditis, RFCA of drug-refractory VT is feasible, safe, and effective. Epicardial RFCA should be considered as an important therapeutic option to increase success rate.
authors.affiliation: Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Dello Russo
authors.forename: Michela
authors.initials: M
authors.lastname: Casella
authors.forename: Maurizio
authors.initials: M
authors.lastname: Pieroni
authors.forename: Gemma
authors.initials: G
authors.lastname: Pelargonio
authors.forename: Stefano
authors.initials: S
authors.lastname: Bartoletti
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.forename: Martina
authors.initials: M
authors.lastname: Zucchetti
authors.forename: Ester
authors.initials: E
authors.lastname: Innocenti
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.forename: Corrado
authors.initials: C
authors.lastname: Carbucicchio
authors.forename: Fulvio
authors.initials: F
authors.lastname: Bellocci
authors.forename: Cesare
authors.initials: C
authors.lastname: Fiorentini
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.forename: Claudio
authors.initials: C
authors.lastname: Tondo
mesh_terms: D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D006328:Cardiac Catheterization; D017115:Catheter Ablation / Q000379:methods*; D004361:Drug Tolerance; D018618:Echocardiography, Doppler, Color; D004562:Electrocardiography; D004699:Endocardium / Q000601:surgery*; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000150:complications* / Q000175:diagnosis; D010496:Pericardium / Q000601:surgery*; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents