Characteristics and Outcomes of Ventricular Tachycardia and Premature
Ventricular Contractions Ablation in Patients with Prior Mitral Valve
Surgery
Abstract
Background: Data regarding ventricular tachycardia (VT) or premature
ventricular complex (PVC) ablation following MVS is limited.) CA can be
challenging given perivalvular substrate in the setting of mitral
annuloplasty or prosthetic valves. Objective: To investigate the
characteristics, safety, and outcomes of radiofrequency catheter
ablation (CA) in patients with prior mitral valve surgery (MVS) and
ventricular arrhythmias (VA). Methods: We identified consecutive
patients with prior MVS who underwent CA for VT or PVC between January
2013- December 2018. We investigated the mechanism of arrhythmia,
ablation approach, peri-operative complications, and outcomes. Results:
In our cohort of 31 patients (77% men, mean age 62.3±10.8 years, left
ventricular ejection fraction 39.2±13.9%) with prior MVS underwent CA
(16 VT; 15 PVC). Access to the left ventricle was via transseptal
approach in 17 patients, and a retrograde aortic approach was used in 13
patients. A combined transseptal and retrograde aortic approach was used
in one patient, and a percutaneous epicardial approach was combined with
trans-septal approach in 1patient. Heterogenous scar regions were
present in 94% of VT patients and scar-related reentry was the dominant
mechanism of VT. Clinical VA substrates involved the peri-mitral area in
6 patients with VT and 5 patients with PVC ablation. No
procedure-related complications were reported. The overall
recurrence-free rate at 1-year was 72.2%; 67% in the VT group and 78%
in the PVC group. No arrhythmia-related death was documented on
long-term follow-up. Conclusion: CA of VAs can be performed safely and
effectively in patients with MVS