title: Impact of a chronic total occlusion in an infarct-related artery on the long-term outcome of ventricular tachycardia ablation.
abstract: BACKGROUND
  In patients with a prior myocardial infarction (MI), angiographic predictors of ventricular tachycardia (VT) recurrence after ablation are lacking. Recently, a proarrhythmic effect of a chronic total occlusion (CTO) in a coronary artery has been suggested.
  
  
  RESULTS
  A total of 191 patients with prior MI were referred to our Hospital between 2010 and June 2013 for a first ablation of VT. Of these, 84 patients (44%) with stable coronary artery disease that underwent a coronary angiography during the index hospitalization were included in this study. A CTO in an infarct-related artery (IRA-CTO) was present in 47 patients (56%). Patients with and without IRA-CTO did not differ in terms of comorbidities, severity of heart failure, presentation of VT or acute outcome of ablation, that was completely successful in 93% of cases. At electroanatomic mapping, IRA-CTO was associated with greater scar and especially with greater area of border zone (34 cm(2) vs. 19 cm(2) , P = 0.001). Median follow-up was 19 months (IQR 18). At follow-up, patients with IRA-CTO had a significantly higher rate of VT recurrence (47% vs. 16%, P = 0.003). At multivariate analysis, IRA-CTO resulted to be an independent predictor of VT recurrence after ablation (HR 4.05, P = 0.004).
  
  
  CONCLUSIONS
  IRA-CTO is an independent predictor of VT recurrence after ablation and identifies a subgroup of patients with high recurrence rate despite a successful procedure. IRA-CTO is associated with greater scars and border zone area; however, this association does not completely justify its proarrhythmic effect.
authors.affiliation: Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.|Arrhythmia Unit, Heart Diseases Institute, Bellvitge Universisty Hospital, Barcelona, Spain.
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Marco
authors.affiliation: Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Paglino
authors.affiliation: Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Oloriz
authors.affiliation: Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Maccabelli
authors.affiliation: Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Baratto
authors.affiliation: Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Vergara
authors.affiliation: Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Bisceglia
authors.affiliation: Arrhythmia Unit, Heart Diseases Institute, Bellvitge Universisty Hospital, Barcelona, Spain.
authors.forename: Ignasi
authors.initials: I
authors.lastname: Anguera
authors.affiliation: Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Sala
authors.affiliation: Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Nicoleta
authors.initials: N
authors.lastname: Sora
authors.affiliation: Arrhythmia Unit, Heart Diseases Institute, Bellvitge Universisty Hospital, Barcelona, Spain.
authors.forename: Paolo
authors.initials: P
authors.lastname: Dallaglio
authors.affiliation: Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Marzi
authors.affiliation: Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Trevisi
authors.affiliation: Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Mazzone
authors.affiliation: Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Della Bella
mesh_terms: D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D002908:Chronic Disease; D015897:Comorbidity; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain; D017180:Tachycardia, Ventricular / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: catheter ablation; coronary artery occlusion; ischemic cardiomyopathy; myocardial infarction; ventricular tachycardia