title: Endo-epicardial homogenization of the scar versus limited substrate ablation for the treatment of electrical storms in patients with ischemic cardiomyopathy.
abstract: OBJECTIVE
  This study investigated the impact on recurrences of 2 different substrate approaches for the treatment of these arrhythmias.
  
  
  BACKGROUND
  Catheter ablation of electrical storms (ES) for ventricular arrhythmias (VAs) has shown moderate long-term efficacy in patients with ischemic cardiomyopathy.
  
  
  METHODS
  Ninety-two consecutive patients (81% male, age 62 ± 13 years) with ischemic cardiomyopathy and ES underwent catheter ablation. Patients were treated either by confining the radiofrequency lesions to the endocardial surface with limited substrate ablation (Group 1, n = 49) or underwent endocardial and epicardial ablation of abnormal potentials within the scar (homogenization of the scar, Group 2, n = 43). Epicardial access was obtained in all Group 2 patients, whereas epicardial ablation was performed in 33% (14) of these patients.
  
  
  RESULTS
  Mean ejection fraction was 27 ± 5. During a mean follow-up of 25 ± 10 months, the VAs recurrence rate of any ventricular tachycardia (VTs) was 47% (23 of 49 patients) in Group 1 and 19% (8 of 43 patients) in Group 2 (log-rank p = 0.006). One patient in Group 1 and 1 patient in Group 2 died at follow-up for noncardiac reasons.
  
  
  CONCLUSIONS
  Our study demonstrates that ablation using endo-epicardial homogenization of the scar significantly increases freedom from VAs in ischemic cardiomyopathy patients.
authors: Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX 78705, USA.
authors: Luigi
authors: L
authors: Di Biase
authors: Pasquale
authors: P
authors: Santangeli
authors: David J
authors: DJ
authors: Burkhardt
authors: Rong
authors: R
authors: Bai
authors: Prasant
authors: P
authors: Mohanty
authors: Corrado
authors: C
authors: Carbucicchio
authors: Antonio
authors: A
authors: Dello Russo
authors: Michela
authors: M
authors: Casella
authors: Sanghamitra
authors: S
authors: Mohanty
authors: Agnes
authors: A
authors: Pump
authors: Richard
authors: R
authors: Hongo
authors: Salwa
authors: S
authors: Beheiry
authors: Gemma
authors: G
authors: Pelargonio
authors: Pietro
authors: P
authors: Santarelli
authors: Martina
authors: M
authors: Zucchetti
authors: Rodney
authors: R
authors: Horton
authors: Javier E
authors: JE
authors: Sanchez
authors: Claude S
authors: CS
authors: Elayi
authors: Dhanunjay
authors: D
authors: Lakkireddy
authors: Claudio
authors: C
authors: Tondo
authors: Andrea
authors: A
authors: Natale
mesh_terms: D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D002921:Cicatrix / Q000503:physiopathology / Q000601:surgery; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D004699:Endocardium / Q000601:surgery*; D056149:Epicardial Mapping; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000150:complications*; D010496:Pericardium / Q000601:surgery*; D011446:Prospective Studies; D012008:Recurrence; D017180:Tachycardia, Ventricular / Q000150:complications* / Q000517:prevention & control / Q000628:therapy*