Myocardial calcification is associated with endocardial ablation failure of post-myocardial infarction ventricular tachycardia

Europace. 2021 Aug 6;23(8):1275-1284. doi: 10.1093/europace/euab003.


Aims: In patients with post-myocardial infarction (post-MI) ventricular tachycardia (VT), the presence of myocardial calcification (MC) may prevent heating of a subepicardial VT substrate contributing to endocardial ablation failure. The aims of this study were to assess the prevalence of MC in patients with post-MI VT and evaluate the impact of MC on outcome after endocardial ablation.

Methods and results: In 158 patients, the presence of MC was retrospectively assessed on fluoroscopy recordings in seven standard projections obtained during pre-procedural coronary angiograms. Myocardial calcification, defined as a distinct radiopaque area that moved synchronously with the cardiac contraction, was detected in 30 patients (19%). After endocardial ablation, only 6 patients (20%) with MC were rendered non-inducible compared with 56 (44%) without MC (P = 0.033) and of importance, 8 (27%) remained inducible for the clinical VT [compared with 9 (6%) patients without MC; P = 0.003] requiring therapy escalation. After a median follow-up of 31 months, 61 patients (39%) had VT recurrence and 47 (30%) died. Patients with MC had a lower survival free from the composite endpoint of VT recurrence or therapy escalation at 24-month follow-up (26% vs. 59%; P = 0.003). Presence of MC (HR 1.69; P = 0.046), a lower LV ejection fraction (HR 1.03 per 1% decrease; P = 0.017), and non-complete procedural success (HR 2.42; P = 0.002) were independently associated with a higher incidence of VT recurrence or therapy escalation.

Conclusion: Myocardial calcification was present in 19% of post-MI patients referred for VT ablation and was associated with a high incidence of endocardial ablation failure.

Keywords: Ablation; Myocardial calcification; Myocardial infarction; Ventricular tachycardia.

MeSH terms

  • Catheter Ablation* / adverse effects
  • Endocardium / diagnostic imaging
  • Endocardium / surgery
  • Humans
  • Myocardial Infarction* / complications
  • Myocardial Infarction* / diagnostic imaging
  • Recurrence
  • Retrospective Studies
  • Tachycardia, Ventricular* / diagnostic imaging
  • Tachycardia, Ventricular* / epidemiology
  • Treatment Outcome