Abstract
Background
Nonreentrant ventricular tachycardia (VT) originates in hearts without structural disease but occasionally can occur in patients with different cardiomyopathies equipped with an implantable cardioverter defibrillator (ICD).
Methods
In a series of 142 ICD recipients with structural heart disease undergoing ablation for recurrent or incessant monomorphic VT, nonreentrant VTs were identified.
Results
Nonreentrant VTs were the cause of appropriate ICD interventions in 12 patients (8.4 %). The underlying heart disease was nonischemic cardiomyopathy in eight patients, prior myocardial infarction in two patients, and valvular cardiomyopathy in two patients with a mean left ventricular ejection fraction of 42 ± 7 %. Unresponsiveness to antitachycardia pacing and repetitive spontaneous re-initiation of the VT after defibrillation was the cause of frequent ineffective ICD interventions including repetitive ICD shocks in these patients. Using ICD interrogation, one or more episodes of a severe electrical storm (≥3 serial efficacious ICD shocks within 15 min) were more frequently documented in patients with nonreentrant VTs (10/12) than in patients with scar-related reentrant VTs (36/115). The origin of the nonreentrant VT was the left ventricular outflow tract in seven patients, the right ventricular outflow tract in three patients, and the tricuspid and mitral annulus in each one patient. Catheter ablation including epicardial mapping in 2 patients eliminated the nonreentrant VT in 11 of 12 patients and prevented recurrent VT storm.
Conclusions
Repetitive nonreentrant VTs may be ineffectively treated by ICD interventions and can be the cause of an electrical storm in different cardiomyopathies.
Similar content being viewed by others
References
Stevenson, W. G., & Soejima, K. (2007). Catheter ablation for ventricular tachycardia. Circulation, 115, 2750–2760.
Iwai, S., Cantillon, D. J., Kim, R. J., Markowitz, S. M., Mittal, S., Stein, K. M., et al. (2006). Right and left ventricular outflow tract tachycardias: evidence for a common electrophysiologic mechanism. Journal of Cardiovascular Electrophysiology, 17, 1052–1058.
O’Donnell, D., Cox, D., Bourke, J., Mitchell, L., & Furniss, S. (2003). Clinical and electrophysiological diffeences between patients with arrhythmogenic right ventricular diysplasia and right ventricular outflow tract tachycardia. European Heart Journal, 24, 801–810.
Atienza, F., Arenal, A., Perez-David, E., Elizaga, J., Ortuno, J., Ledesma-Carbayo, J., et al. (2013). New diagnostic and therapeutic approaches to treat ventricular tachycardias originating at the summit of the left ventricle: role of merged hemodynamic-MRI and alternative ablation sources. Circulation. Arrhythmia and Electrophysiology, 6, e80–e84.
Ellis, E. R., Shvilkin, A., & Josephson, M. E. (2014). Nonreentrant ventricular arrhythmias in patients with structural heart disease unrelated to abnormal myocardial substrate. Heart Rhythm, 11, 946–952.
Lerman, B. B. (2009). Ventricular tachycardia in patients with structurally normal hearts. In D. P. Zipes & J. Jalife (Eds.), Cardiac electrophysiology: from cell to bedside (5th ed., pp. 657–667). Philadelphia: Saunders.
Pogwizd, S. M., Hoyt, R. H., Saffitz, J. E., Corr, P. B., Cox, J. L., & Cain, M. E. (1992). Reentrant and focal mechanisms underlying ventricular tachycardia in the human heart. Circulation, 86, 1872–1887.
Proietti, R., & Sagone, A. (2011). Electrical storm: incidence, prognosis and therapy. Indian Pacing and Electrophysiology Journal, 11, 34–42.
Reithmann, C., Herkommer, B., Huemmer, A., von Hoch, F., & Fiek, M. (2013). The risk of delayed atrioventricular and intraventricular conduction block following ablation of bundle branch reentry. Clinical Research in Cardiology, 102, 145–152.
Aliot, E. M., Stevenson, W. G., Almendral-Garrote, J. M., Bogun, F., Calkins, C. H., Delacretaz, E., et al. (2009). EHRA/HRS Expert Consensus on catheter ablation of ventricular arrhythmias. Europace, 11, 771–817.
Sosa, E., Scanavacca, M., D’Avila, A., & Pilleggi, E. (2007). A new technique to perform epicardial mapping in the eletrophysiological laboratory. Journal of Cardiovascular Electrophysiology, 7, 531–536.
Reithmann, C., Fiek, M., Hahnefeld, A., Ulbrich, M., & Steinbeck, G. (2012). Recording of low-amplitude diastolic electrograms through the coronary veins: a guide for epicardial ventricular tachycardia ablation. Europace, 14, 865–871.
Sweeney, M. O. (2004). Antitachycardia pacing for ventricular tachycardia using implantable cardioverter defibrillators. Substrates, methods, and clinical experience. PACE, 27, 1292–1305.
Miragoli, M., Salvarani, N., & Rohr, S. (2007). Myofibroblasts induce ectopic activity in cardiac tissue. Circulation Research, 101, 755–758.
Reithmann, C., Hahnefeld, A., Oversohl, N., Ulbrich, M., Remp, T., & Steinbeck, G. (2007). Reinitiation of ventricular macroreentry within the His-Purkinje system by back-up ventricular pacing—a mechanism of ventricular tachycardia storm. Pacing and Clinical Electrophysiology, 30, 1–11.
Moss, A. J., Schuger, C., Beck, C. A., Brown, M. W., Cannom, D. S., Daubert, J. P., et al. (2012). Reduction in inappropriate therapy and mortality through ICD programming. New England Journal of Medicine, 367, 2275–2283.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fiek, M., Remp, T., Fleckenstein, M. et al. Incidence and relevance of nonreentrant monomorphic ventricular tachycardia in patients with frequent implantable cardioverter defibrillator interventions. J Interv Card Electrophysiol 42, 151–160 (2015). https://doi.org/10.1007/s10840-015-9973-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10840-015-9973-8