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  • Title: Nonischemic cardiomyopathy substrate and ventricular tachycardia in the setting of coronary artery disease.
    Author: Aldhoon B, Tzou WS, Riley MP, Lin D, Callans DJ, Hutchinson MD, Dixit S, Garcia FC, Zado ES, Marchlinski FE.
    Journal: Heart Rhythm; 2013 Nov; 10(11):1622-7. PubMed ID: 23973949.
    Abstract:
    BACKGROUND: Patients with coronary artery disease (CAD) may have ventricular tachycardia (VT) from a separate nonischemic process. Catheter ablation in these patients can be misguided by abnormalities of coronary arteries. OBJECTIVE: To identify (1) the prevalence of unanticipated nonischemic VT in patients with known CAD presenting with VT and (2) the substrate and VT characteristics of this unique subset of patients. METHODS: We examined consecutive patients referred for VT catheter ablation who had a history of myocardial infarction and angiography documented CAD with presumed ischemic VT. Patients with low-voltage zones and/or VT origin inconsistent with CAD distribution were included for further analysis. RESULTS: Of 732 patients, 9 (1.2%) (7 men; median age 74 years; ejection fraction 30%) fulfilled inclusion criteria. Endocardial left ventricular scar inconsistent with CAD distribution was found in 8 patients. In 1 patient, only epicardial left ventricular scar was found. The distribution of low voltage (<1.5 mV) was predominantly around the aortic and mitral valves. Thirty-one VTs were induced in 8 patients. Most VTs had right bundle branch block (68%); of these VTs, 67% had an R/S transition zone later than lead V4 consistent with basal VT origin. Epicardial ablation was necessary in 2 patients. During follow-up (30 [25-39] months), 7 of 9 patients (78%) were free of recurrent VT. CONCLUSIONS: A small but important subgroup of patients with CAD and VT has a nonischemic substrate/etiology for VT. The presence of multiple VTs with basal origin suggests a potential nonischemic perivalvular substrate and possible need for epicardial VT ablation.
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