Early Referral for Ablation of Scar-Related Ventricular Tachycardia Is Associated With Improved Acute and Long-Term Outcomes

Abstract

Background— The effects of time to referral for catheter ablation (CA) of scar-related ventricular tachycardia (VT) on acute success, VT recurrence, and cardiac mortality are unclear. Methods and Results— We investigated 300 patients after CA of sustained VT. CA was performed within 30 days after the first documented VT in 75 (25%) patients (group 1), between 1 month and 1 year in 84 (28%) patients (group 2), and >1 year after the first VT occurrence in 141 (47%) patients (group 3). The end points were noninducibility of any VT after CA (acute success), VT recurrence and cardiac mortality after 2 years. Acute success was achieved in 66 (88%) patients in group 1, 68 (81%) in group 2, and in 99 (70.2%) in group 3 ( P =0.008). During the 2-year follow-up period, VT recurred in 28 (37.3%) patients in group 1, 52 (61.9%) patients in group 2, and 91 (64.5%) patients in group 3 ( P <0.0001). Recurrence-free survival was higher in group 1, as compared with group 2 (hazard ratio [HR], 1.85; P =0.009) and group 3 (HR, 2.04; P =0.001). No survival difference was observed between groups 1 and 2 (HR, 0.85; P =0.68) and groups 1 and 3 (HR, 1.13; P =0.73). β-blocker therapy, VT of ischemic origin, and complete success were associated with VT-free survival. VT recurrence (HR, 1.91; P =0.037) predicted cardiac mortality. Conclusions— CA of scar-related VT performed within 30 days after the first documented VT was associated with improved acute and long-term success. VT recurrence, but not the early referral for CA, was associated with cardiovascular mortality.

Reassessing Noninducibility as Ablation Endpoint of Post-Infarction Ventricular Tachycardia

“…In line with a recent publication, if these patients where referred for ablation after the first documented VT episode, the outcome was excellent. 16 No patient fulfilling these criteria had events during the first year of follow-up, further supporting an early ablation in this patient population. Inducibility of any VT after ablation seems to be therefore a good predictor of VT recurrence in patients with moderately depressed LV function, and noninducibility might be a sufficient end point for the ablation procedure in these patients.…”

Utility of high density multielectrode mapping during ablation of scar‐related ventricular tachycardia

“…Catheter ablation is an effective therapeutic approach for patients with scar‐related ventricular tachycardia (VT) . A detailed knowledge of the VT substrate is mandatory in this setting in order to identify the potential VT circuits and to delineate the optimal ablation strategy for each patient.…”

A review of the literature on cardiac electrical activity between fibroblasts and myocytes

“…Evidence collected from clinical ablation procedures also provides some support for electrical coupling between myocytes and fibroblasts. Many patients suffering from arrhythmias undergo catheter ablation, a treatment aimed at creating scar tissue to disrupt arrhythmogenic electrical circuits in the atria or ventricles(Dinov et al, 2014; Ghanbari et al, 2014). This treatment is based on the assumption that scar tissue is non conductive and poses a physical barrier to conduction.…”