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Characteristics and Outcomes of Ventricular Tachycardia and Premature Ventricular Contractions Ablation in Patients with Prior Mitral Valve Surgery
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  • Fouad Khalil,
  • Takumi Toya,
  • Malini Madhavan,
  • Mohammed Badawy,
  • Suraj Kapa,
  • Siva Mulpuru,
  • Konstantinos Siontis,
  • Christopher DeSimone,
  • Abhishek Deshmukh,
  • Young-mei Cha,
  • Paul Friedman,
  • Thomas Munger,
  • Samuel Asirvatham,
  • Ammar Killu
Fouad Khalil
Mayo Clinic
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Takumi Toya
Mayo Clinic
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Malini Madhavan
Mayo Clinic
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Mohammed Badawy
Mayo Clinic
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Suraj Kapa
Mayo Clinic
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Siva Mulpuru
Mayo Clinic
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Konstantinos Siontis
Mayo Clinic
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Christopher DeSimone
Mayo Clinic
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Abhishek Deshmukh
Mayo Clinic
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Young-mei Cha
Mayo Clinic
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Paul Friedman
Mayo Clinic
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Thomas Munger
Mayo Clinic West 16A
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Samuel Asirvatham
Mayo Clinic
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Ammar Killu
Mayo Clinic
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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

Peer review status:IN REVISION

15 Jun 2021Submitted to Journal of Cardiovascular Electrophysiology
30 Jun 2021Assigned to Editor
30 Jun 2021Submission Checks Completed
02 Jul 2021Reviewer(s) Assigned
20 Jul 2021Review(s) Completed, Editorial Evaluation Pending
23 Jul 2021Editorial Decision: Revise Minor
11 Sep 20211st Revision Received