title: A stepwise approach to the management of postinfarct ventricular tachycardia using catheter ablation as the first-line treatment: a single-center experience.
abstract: BACKGROUND
  The occurrence of ventricular tachycardia (VT) after myocardial infarction is associated with poorer prognosis. In such patients, implantable cardioverter-defibrillators are recommended. Catheter ablation of VT is currently recommended only as an adjunctive therapy. Whether a successful VT ablation alone might be a viable strategy in some of these patients, however, remains unknown. The aim of the present study was to evaluate this strategy.
  
  
  RESULTS
  Between January 2002 and December 2011, 189 patients with cardiomyopathy underwent 259 VT ablations in our center. Forty-five patients (mean age, 65.2±9.6 years; 91% men) with a history of myocardial infarction and mean left ventricular ejection fraction of 39.7±9.7% matched the study criteria and were included in this analysis. Acute success was obtained in 40 of 45 patients (88.9%). During a follow-up, on the basis of our stepwise algorithm (using acute success, repeat electrophysiological study, and recurrence of VT), 19 of 45 patients (42.2%) underwent implantable cardioverter-defibrillators implantation. During a median follow-up of 4.5 (interquartile range, 2.1-7.0) years, all-cause mortality occurred in 14 of 45 patients (31.1%). Using multivariate Cox regression analysis, age (hazard ratio, 1.13; 95% confidence interval, 1.03-1.22; P=0.007) was the only independent predictor of mortality, whereas implantable cardioverter-defibrillators implantation was not (hazard ratio, 0.54; 95% confidence interval, 0.18-1.64; P=0.28)
  
  
  CONCLUSIONS
  Our results suggest that a stepwise approach to the management of VT with ablation as a first-line treatment in postinfarct patients presenting with VT might be a reasonable option. Further studies are required to confirm these results.
authors.affiliation: Department of Cardiology, CHU de Nancy, University Hospital Nancy, Nancy, France.
authors.forename: Maheshwar
authors.initials: M
authors.lastname: Pauriah
authors.forename: Gabriel
authors.initials: G
authors.lastname: Cismaru
authors.forename: Isabelle
authors.initials: I
authors.lastname: Magnin-Poull
authors.forename: Marius
authors.initials: M
authors.lastname: Andronache
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Sellal
authors.forename: Jérôme
authors.initials: J
authors.lastname: Schwartz
authors.forename: Béatrice
authors.initials: B
authors.lastname: Brembilla-Perrot
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sadoul
authors.forename: Etienne
authors.initials: E
authors.lastname: Aliot
authors.forename: Christian
authors.initials: C
authors.lastname: de Chillou
mesh_terms: D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006329:Heart Conduction System / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000150:complications* / Q000503:physiopathology; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D013997:Time Factors