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Master Thesis

Évaluation des facteurs de risque de mortalité et de récurrence de troubles du rythme ventriculaires chez les patients avec une cardiopathie structurelle dans les suites d’une ablation d’orage rythmique

Abstract : Background : Electrical storm (ES) occurring in patients with a cardiomyopathy can lead to bad evolution. Caheter ablation (CA) has evolved into a prior treatment and this study aims to identify predictive factors of mortality and recurrence of ventricular tachycardia (VT) after a radiofrequency. Methods and results : 87 patients that had CA for a drug-resistant ES were included : 36 patients with chronic artery disease, 20 with recent myocardial infarction, 14 with arrhythmogenic right ventricular dysplasia, 11 with idiopathic dilated cardiomyopathy, 3 with valvular cardiomyopathy, 2 with hypertrophic cardiomyopathy and 1 with a previous myocarditis. 37 patients (43%) presented a recurrence of tachyarrhythmia within 1 month after the first radiofrequency, 18 patients underwent multiple CA. Overall, 48 patients (55%) did not have a recurrence of VT after the last CA. Independent predictive factor of early-VT recurrence were recent myocardial infarction (OR=2,343 IC95%[1,149 ; 4,778] p=0,019) and positive or undone ventricular stimulation (OR=0,425 IC95%[0,218 ; 0,828] p=0,012). 20% of patients died within one month (n=17). Male gender (OR=0,208 IC95%[0,063 ; 0,693] p=0,011), low tolerance of VT (OR=8,486 IC95%[1,084 ; 66,40] p=0,042), general anaesthesia (OR=3,163 IC95%[1,012 ; 9,885] p=0,048] and VT recurrence after first CA (OR=4,393 IC95%[1,209 ; 15,97] p=0,025) were associated with early mortality. Conclusion : Catheter ablation is an effective treatment of electrical storm when procedure is a complete success. A population at high risk of death may be identified and would benefit of a strategy considering heart transplantation and ventricular assistance device in case of CA failure.
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Submitted on : Thursday, March 21, 2019 - 7:49:35 PM
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Ludivine Oliveira da Silva. Évaluation des facteurs de risque de mortalité et de récurrence de troubles du rythme ventriculaires chez les patients avec une cardiopathie structurelle dans les suites d’une ablation d’orage rythmique. Human health and pathology. 2017. ⟨dumas-02076049⟩

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