CATHETER ABLATION OF VENTRICULAR-TACHYCAR DIA BY FULGURATION - RESULTS IN 86 CASES

Between 1983 and 1991, 86 cases of ventricular tachycardia (VT) resist ant to antiarrhythmic therapy were treated by endocardious catheter fu lguration : there were 21 cases of right ventricular dysplasia (RVD), 35 chronic myocardial infarctions (MI), 11 dilated cardiomyopathies (D CM), 10 bundle branch VT, 5 idiopathic septal VT, 3 operated Fallot pr ocedures, 1 Ebstein's anomaly. There were 69 men and 17 women aged 14 to 76 years (average 45 +/- 18 years). The ejection fraction was under 30 % in 37 cases. Forty-five VTs were permanent or recurred several t imes daily ; 6 were inducible despite drug therapy and 35 patients had monthly recurrences. A total of 141 different forms of VT were treate d in 1 33 procedures. One session Was sufficient in 49 cases : 2 sessi ons were required in 29 cases ; 3 sessions in 6 cases and 4 sessions i n 2 cases. A total of 480 DC shocks were delivered with energies of 16 0 to 300 joules. The CPK-MB levels were 37 +/- 30 i.u./l. The followin g complications were observed : 7 perioperative deaths. 2 cardiac tamp onades requiring surgical drainage, 1 permanent AV block, 5 reversible left ventricular failures. Follow up concerned 79 patients: 5 were fo llowed up for less than 3 months with death occurring from cardiac fai lure which had been pre.ent before the ablation procedure without recu rrence of VT. Seventy-four patients were followed up from 3 to 111 mon ths (56 +/- 33 months). Thirty-two patients were without any antiarrhy thmic therapy and had no recurrence of VT. Two of these patients devel oped a different form of VT 2 and 6 years after the catheter ablation. Twenty-nine patients were controlled by previously ineffective antiar rhythmic therapy: 3 of these patients had late recurrence of VT and on e died from a lethal arrhythmia. There were 10 early failures and 3 un interpretable cases. On the basis of intention to treat, the clinical sucess rate (with and without associated antiarrhythmic therapy) was 8 0 %: 60 % in septal VT, 81 % in RVD, 78 % in MI and 100 % in bundle br anch VT. On the basis of interpretable results (excluding peroperative deaths and uninterpretable results), out of 76 cases, the failure rat e was 11 % and the efficacy of catheter ablation was 89 %. Fulguration alone or associated with antiarrhythmic therapy is effective but not simple nor without risk in the treatment of VT.