Long-term outcomes of different ablation strategies for ventricular tachycardia in patients with structural heart disease: systematic review and meta-analysis

Abstract

In patients with SHD who had VT related mainly to ischaemic substrates, there was a significantly lower risk of the composite primary outcome of long-term VA recurrence and all-cause mortality among those undergoing substrate modification compared to standard ablation. Long-term success is improved when performing complete substrate modification.

Percutaneous ventricular assist devices for catheter ablation of ventricular tachycardia in structural heart disease: “A Conditio Sine Qua Non”?

“…A statistically significant decrease in the composite endpoint of VT recurrence/all‐cause mortality associated with substrate modification as compared with standard ablation of stable VTs (risk ratio [RR] 0.57, 95% confidence interval [CI] 0.40–0.81) was found. Patients with complete substrate modification (defined as elimination of all late or fractionated potentials) had a decreased VT recurrence as compared to patients with incomplete substrate modification (RR 0.39, 95% CI 0.27–0.58) . In addition to the detected improved arrhythmia‐free survival, which is in accordance with previously available evidence, the meta‐analysis provides novel evidence suggesting a mortality benefit in patients undergoing substrate‐based ablation …”

“…Additionally, recent evidence implies that VT induction and mapping before substrate ablation only prolongs the procedure, radiation exposure, and the need for electrical cardioversion without increasing acute and long-term ablation outcomes, when compared with substrate ablation as the first step. We conducted a meta-analysis comparing substrate-based versus standard ablation of VT. 14 15 There was no significant difference in age or ejection fraction between the groups. Procedure times were longer for the PVAD group and there was no difference in inducibility at the end of the procedure between the PVAD and non-PVAD group (77 vs. 67%, P = 0.69).…”

“…Additionally, recent evidence implies that VT induction and mapping before substrate ablation only prolongs the procedure, radiation exposure, and the need for electrical cardioversion without increasing acute and long-term ablation outcomes, when compared with substrate ablation as the first step. We conducted a meta-analysis comparing substrate-based versus standard ablation of VT. 14 We analyzed the long-term outcomes of standard ablation of stable VTs versus substrate modification, and of complete versus incomplete substrate modification in patients with structural heart disease (SHD). The main outcomes were a composite of long-term VT recurrence and all-cause mortality of standard ablation of stable VT versus substrate modification, and long-term VT recurrence in complete versus incomplete substrate modification.…”

Ten‐year trends in catheter ablation for ventricular tachycardia vs other interventional procedures in Australia

“…As such ablation is recommended by multiple guidelines for the management of drug‐refractory ventricular arrhythmias . Mirroring such recommendations, there has been a large growth of VT ablations worldwide . Whether similar trends are seen in Australia remains unknown.…”

“…11 Mirroring such recommendations, there has been a large growth of VT ablations worldwide. [12][13][14][15][16] Whether similar trends are seen in Australia remains unknown. We have previously shown that catheter ablation of atrial fibrillation (AF), the most common cardiac arrhythmia in humans, has grown at an exponential rate, at up to 39.8% per year, when compared to other common interventional cardiovascular procedures, such as percutaneous coronary intervention (PCI).…”