Radiofrequency ablation of drug refractory ventricular tachycardia related to cocaine use: a feasibility, safety, and efficacy study.
BACKGROUND
Cocaine use is a known but rare cause of cardiac arrhythmias. Ventricular arrhythmias related to cocaine may not respond to antiarrhythmic drugs and may need treatment with radiofrequency ablation.


OBJECTIVE
We describe the clinical and electrophysiological characteristics of cocaine-related ventricular tachycardia (VT) from a multicenter registry.


METHODS
Subjects presenting with VT related to cocaine use and being considered for radiofrequency ablation have been included in the study. Patients who were refractory to maximal medical therapy underwent radiofrequency ablation of the VT. Clinical, procedural variables, efficacy, and safety outcomes were assessed.


RESULTS
A total of 14 subjects met study criteria (age 44 ± 13, range 18- to 68-year-old with 79% male, 71% Caucasian). MRI showed evidence of scar only in 43% of patients (6/14). The mechanism of VT was focal in 50% (n = 7) and scar related reentry in 50% (n = 7) based on 3D mapping. The mean VT cycle length was 429 ± 96 milliseconds. The site of origin was epicardial in 16% (3/18) of VTs. Most clinical VTs were hemodynamically stable (75%). Mean ejection fraction at the time of admission was 44 ± 14%. Duration of procedure was 289 ± 50 minutes. One subject developed pericardial tamponade requiring drainage. At 18 ± 11 months follow-up, freedom from arrhythmia was seen in 86% (1 case lost to follow-up and 2 died).


CONCLUSIONS
Radiofrequency ablation is not only feasible but also safe and effective in patients who have drug refractory VT related to chronic cocaine use.
KU Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital, Kansas City, Kansas, USA.
Dhanunjaya
D
Lakkireddy
Arun
A
Kanmanthareddy
Mazda
M
Biria
Yeruva
Y
Madhu Reddy
Jayasree
J
Pillarisetti
Srijoy
S
Mahapatra
Loren
L
Berenbom
Larry
L
Chinitz
Donita
D
Atkins
Sudharani
S
Bommana
Roderick
R
Tung
Luigi
L
DI Biase
Kalyanam
K
Shivkumar
Andrea
A
Natale
D000293:Adolescent; D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D017115:Catheter Ablation / Q000009:adverse effects; D019970:Cocaine-Related Disorders / Q000150:complications*; D004351:Drug Resistance; D022062:Electrophysiologic Techniques, Cardiac; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
D000889:Anti-Arrhythmia Agents
cocaine; focal mechanism; myocardial infarction; reentry; ventricular tachycardia