Decennial follow-up in patients with recurrent tachycardia originating from the right ventricular outflow tract: electrophysiologic characteristics and response to treatment

• Published in: European heart journal Vol. 28; no. 19; pp. 2338 - 2345
• Main Authors: Ventura, Rodolfo, Steven, Daniel, Klemm, Hanno U., Lutomsky, Boris, Müllerleile, Kai, Rostock, Thomas, Servatius, Helge, Risius, Tim, Meinertz, Thomas, Kuck, Karl-Heinz, Willems, Stephan
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.10.2007; Oxford Publishing Limited (England)
• Subjects: Adult; Anti-Arrhythmia Agents - therapeutic use; Biological and medical sciences; Cardiac dysrhythmias; Cardiac Electrophysiology; Cardiology. Vascular system; Catheter Ablation; Coronary Angiography; Drugs; Echocardiography; Exercise Test; Female; Follow-Up Studies; Heart; Humans; Idiopathic ventricular tachycardia; Male; Medical sciences; Middle Aged; Prognosis; Recurrence; Retrospective Studies; Tachycardia, Ventricular - mortality; Tachycardia, Ventricular - physiopathology; Tachycardia, Ventricular - therapy; Time Factors; Treatment Outcome; Drugs; Catheter ablation; Idiopathic ventricular tachycardia; Drug; Relapse; Arrhythmia; Right ventricle; Patient follow-up; Characteristic; Idiopathic; Catheter; Cardiovascular disease; Ventricular tachycardia; Recurrent; Ablation; Phlebology; Response; Treatment; Characteristics; Heart disease; Circulatory system; Cardiology
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehm293

Aims In the setting of right ventricular outflow tract-tachycardia (RVOT-T), data about long-term follow-up (FU) with respect to the therapeutic strategies are missing. All patients (pts) referred to our institution during the last 20 years for the treatment of RVOT-T were studied in a retrospective analysis to assess mortality and efficacy of treatment. Methods and results One hundred and thirty-three patients (77 female; 39 ± 13 years) with sustained RVOT-T were included in this study. At the time of first presentation, diagnosis of RVOT-T was made by complete invasive and non-invasive diagnostic assessment, including electrophysiology study and two-dimensional echocardiography. After 135 ± 68 months (median 136, range 29–248), patients were invited to undergo clinical assessment. Of the 133 pts, 127 (95%) survived and six (5%) died from non-cardiac disease. Anti-arrhythmic (AA) drugs were given to 62 of the 133 pts (47%); of them 32 (52%) had recurrences during follow-up. The mean time to recurrence was 10.02 years (95% CI 7.46–12.59). The other 71 study patients (53%) underwent catheter ablation. The procedure was successful in 58 pts (82%). During follow-up, 30 (52%) of the 58 successfully treated patients had recurrences of RVOT-T. The mean time to recurrence was 6.28 years (95% CI 4.96–7.6). RVOT-T recurrences were similar in morphology to those treated previously in 33% and different in 67% of cases. Conclusions Long-term follow-up in patients with RVOT-T is favourable. Catheter ablation is effective in this setting. However, late recurrences with similar or different morphology may arise in half of the patients after initially successful treatment. AA drug therapy is a valid initial therapeutic option, since it is effective in about half of the patients.