title: Urgent catheter ablation for sustained ventricular tachyarrhythmias in patients with acute heart failure decompensation.
abstract: OBJECTIVE
  Ventricular tachycardia (VT) and ventricular fibrillation (VF) are not uncommon in patients hospitalized with acute heart failure (AHF). We sought to evaluate the efficacy of urgent radiofrequency catheter ablation (RFCA) for recurrent VT/VF during AHF decompensations.
  
  
  RESULTS
  The present study retrospectively analysed the data of 15 consecutive patients (69 ± 9 years, ischaemic heart disease in 10), who underwent urgent RFCA for frequent drug-refractory VT/VF episodes during an AHF decompensation with pulmonary congestion. The target arrhythmias were clinically documented monomorphic VTs in 10 patients, frequent premature ventricular contractions (PVCs) triggering VF in 4, and both in 1. The mean left ventricular ejection fraction was 26 ± 8%. The maximum number of arrhythmia episodes over 24 h was 9.1 ± 11.7. All RFCA sessions were completed without any major complications except for a temporary deterioration of pulmonary congestion in three patients (20%). Elimination and non-inducibility of the target arrhythmias were achieved in 13 patients (87%). Successful ablation site electrograms showed Purkinje potentials for all 5 PVCs triggering VF and 4 of 14 clinically documented monomorphic VTs (29%). Five patients (33%) underwent second sessions 10 ± 4 days after the first session for acute recurrences. Sustained VT/VF was completely suppressed during admission in 12 patients (80%), and the AHF ameliorated in 13 patients (93%). Twelve patients (80%) were discharged alive.
  
  
  CONCLUSIONS
  Urgent RFCA for drug-resistant sustained ventricular tachyarrhythmias during AHF decompensations would be an appropriate therapeutic option. Purkinje fibres can be ablation targets not only in those with PVCs triggering VF, but also in those with monomorphic VT.
authors.affiliation: Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
authors.forename: Meiso
authors.initials: M
authors.lastname: Hayashi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Miyauchi
authors.forename: Hiroshige
authors.initials: H
authors.lastname: Murata
authors.forename: Kenta
authors.initials: K
authors.lastname: Takahashi
authors.forename: Ippei
authors.initials: I
authors.lastname: Tsuboi
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Uetake
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hayashi
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Horie
authors.forename: Kenji
authors.initials: K
authors.lastname: Yodogawa
authors.forename: Yu-Ki
authors.initials: YK
authors.lastname: Iwasaki
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Mizuno
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000379:methods*; D002908:Chronic Disease; D003422:Critical Care / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*
keywords: Acute heart failure; Purkinje fibre; Radiofrequency catheter ablation; Ventricular fibrillation; Ventricular tachycardia