Sustained Ventricular Tachycardia Associated With Corrective Valve Surgery

R. E. Eckart, T. W. Hruczkowski, U. B. Tedrow, B. A. Koplan, L. M. Epstein, W. G. Stevenson
2007 Circulation  
Background-The causes of sustained monomorphic ventricular tachycardia (VT) after cardiac valve surgeries have not been studied extensively, although bundle-branch reentry has been reported. Methods and Results-Records of 496 patients referred for electrophysiology study and catheter ablation of recurrent VT were reviewed. Twenty patients (4%) had VT after aortic or mitral valve surgery in the absence of known myocardial infarction. The median age was 53 years, and the median ejection fraction
more » ... as 45%. In 4 patients, VT occurred early after surgery, and electrophysiology study was performed 3 to 10 days later. In the remaining patients, electrophysiology study was performed a median of 12 years (interquartile range 5 to 15 years) after surgery. Sustained VT was inducible in 17 patients. VT was attributed to scar-related reentry in 14 patients (70%) and to bundle-branch reentry in 2 (10%). Multiple VTs were present in 9 of 14 patients with scar-related reentry. A total of 42 induced VTs were targeted for ablation. Of the 14 patients with scar-related reentry, 9 (64%) had periannular scar, and 10 (71%) had an identifiable endocardial circuit isthmus. Ablation abolished 41 (98%) of the 42 targeted VTs. At a median follow-up of 2.1 years, 3 deaths occurred 8 to 14 months after ablation. One patient with incessant VT early after valve surgery suffered a stroke with residual hemianopsia. Of the 20 patients, 3 required repeat ablation after recurrence, and 2 of these who were not inducible during electrophysiology study had clinical recurrence that necessitated ablation. Conclusions-Sustained VT after valve surgery appears to be bimodal in presentation, occurring either early after surgery or years later. In this referral population, reentry in a region of scar is more common than bundle-branch reentry. Catheter ablation can be successful. S ustained monomorphic ventricular tachycardia (VT) after valve surgery is both uncommon and not well-studied. Cases of focal VT 1 and small series of bundle-branch reentry have been reported. 2,3 Information is limited as to the cause and interventional treatment of other types of VT in these patients. We report a cohort of patients with monomorphic VT after valve surgery who underwent detailed electrophysiology study with mapping that elucidates the likely substrate and mechanisms of VT in this population.
doi:10.1161/circulationaha.107.703157 pmid:17923574 fatcat:wgkcgeuanzbnppcyngfvqcfjrq