Prophylactic catheter ablation for induced monomorphic ventricular tachycardia in patients with implantable cardioverter defibrillators as primary prevention

Hayashi, Takekuni; Fukamizu, Seiji; Hojo, Rintaro; Komiyama, Kanki; Tanabe, Yasuhiro; Tejima, Tamotsu; Soejima, Kyoko; Nishizaki, Mitsuhiro; Hiraoka, Masayasu; Ako, Junya; Momomura, Shin‐ichi; Sakurada, Harumizu

doi:10.1093/europace/eut050

Cited by 17 publications

(8 citation statements)

References 25 publications

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“…In every day practice, NIPS results are also widely used for evaluation of effectiveness of ablative treatment of VT despite limited data from prospective trials. In the future, induction of monomorphic VT at NIPS may be possibly used for identification of patients who could benefit from prophylactic VT ablation; however, our study showed a high negative rather than positive predictive value of NIPS. Nevertheless, future ablative treatment of VT/VF may also consist of more effective, safe, and noninvasive techniques, allowing implementation of VT/VF ablation in more preventive manner.…”

Section: Discussionmentioning

confidence: 58%

“…However, when these therapies occur, ICD interventions can be painful and have negative prognostic value . Modern methods of prevention of ventricular tachycardia (VT) or ventricular fibrillation (VF) in patients with ICD include proper ICD programming, catheter ablation, or treatment with antiarrhythmic drugs . However, prophylactic catheter ablation is rarely performed, whereas antiarrhythmic drugs have limited efficacy and may be harmful.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic value of noninvasive programmed stimulation in patients with implantable cardioverter defibrillator

Futyma¹,

Sander²,

Głuszczyk³

et al. 2018

Pacing Clinical Electrophis

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Background: Implantable cardioverter defibrillator (ICD) offers an opportunity to examine vulnerability to ventricular tachycardia (VT) or ventricular fibrillation (VF) by performing noninvasive programmed ventricular stimulation (NIPS). Whether NIPS can predict VT/VF recurrences has not yet been established.Purpose: To examine the predictive value of NIPS for identification of patients with VT/VF recurrences. Methods:The study group consisted of consecutive 105 ICD recipients included in the prospective NIPS-ICD study (ClinicalTrials ID: NCT02373306) (88 males, age 65 ± 11 years). The patients underwent NIPS using the protocol up to three premature extrastimuli at 600-500-and 400-ms drive cycle lengths. The endpoint of NIPS was induction of sustained VT or VF or completion of the protocol.Results: VT/VF was induced in 29 (27.6%) patients. During a 12-month follow-up NIPS-inducible patients had significantly more frequently appropriate ICD therapy than noninducible patients (17% vs 4%, P = 0.023). NIPS-induced VT/VF had a sensitivity of 63%, specificity of 75%, positive predictive value of 17%, and negative predictive value of 96% for identification of patients with future VT/VF. Apart from NIPS, age ≥ 65 years, QRS duration, treatment with angiotensinconverting enzyme, history of coronary artery bypass grafting, history of VT/VF prior to NIPS, and prior appropriate ICD therapy were also associated with VT/VF recurrences. Multivariate analysis showed that, together with QRS duration, NIPS result was an independent predictor of future VT/VF. Predictive value of NIPS was significantly higher in ischemic than nonischemic patients.Conclusions: NIPS result is associated with future VT/VF. Noninducibility at NIPS identifies those patients with high accuracy who will have uneventful follow-up. K E Y W O R D Simplantable cardioverter defibrillator, noninvasive programmed ventricular stimulation, prognostic value

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Section: Discussionmentioning

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Prognostic value of noninvasive programmed stimulation in patients with implantable cardioverter defibrillator

Futyma¹,

Sander²,

Głuszczyk³

et al. 2018

Pacing Clinical Electrophis

View full text Add to dashboard Cite

show abstract

“…Second, the risk restratification analysis may be used to identify which patients remain at high risk of VA. This is of particular interest in the ICM cohort where there is growing interest in prophylactic VT ablation . Patient selection for VT ablation remains a controversial area with some centers advocating ablation in all patients receiving an ICD with other centers choosing to ablate only in incessant drug refractory VT.…”

Section: Discussionmentioning

confidence: 99%

Substrate‐dependent risk stratification for implantable cardioverter defibrillator therapies using cardiac magnetic resonance imaging: The importance of T1 mapping in nonischemic patients

Claridge

Mennuni

Jackson

et al. 2017

Cardiovasc electrophysiol

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“…10 While SMASH-VT showed a significant reduction in ICD shocks in patients who received ICD for secondary prevention, the VTACH trial 10 demonstrated similar benefit from ablation before ICD implantation in patients with tolerated VT. Several single-center retrospective reports strongly suggest that earlier intervention may translate into improved clinical outcomes, highlighting the promising role of upfront ablation. Frankel et al 21 showed that earlier referral for ablation led to an improved 1-year survival free of VT. Hayashi and colleagues 22 in a retrospective study demonstrated improved event-free survival after prophylactic VT ablation in a primary prevention population. Dinov et al 23 demonstrated that early referral for VT ablation was associated with improved acute and long-term freedom from VT recurrence.…”

Section: Current Statementioning

confidence: 97%

Catheter Ablation at the Forefront: The Tribulations of Clinical Trials

Bradfield¹,

Tung²

2016

JICRM

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ABSTRACT. Radiofrequency ablation (RFA) has become an essential component of ventricular tachycardia (VT) management. In the era of implantable cardioverter-defibrillators (ICDs), antiarrhythmic therapy and RFA are frequently required for patients with both primary prevention and secondary prevention indications for ICD implant. ''VT ablation'' encompasses ablation across a spectrum of various ventricular arrhythmias. In addition to ablation of monomorphic VT in the setting of structural heart disease, the evolving field also includes VT in structurally normal hearts (idiopathic VT), premature ventricular contractions (PVC) ablation (for symptoms and optimization of cardiomyopathy), and ablation of ventricular fibrillation via targeting of triggering PVCs. While these sub-categories of VT ablation represent significant advancement in the breadth of the field, the focus of this article is to review the evidence for catheter ablation of monomorphic VT in the setting of structural heart disease and to discuss future studies that are anticipated.

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Prophylactic catheter ablation for induced monomorphic ventricular tachycardia in patients with implantable cardioverter defibrillators as primary prevention

Cited by 17 publications

References 25 publications

Prognostic value of noninvasive programmed stimulation in patients with implantable cardioverter defibrillator

Prognostic value of noninvasive programmed stimulation in patients with implantable cardioverter defibrillator

Substrate‐dependent risk stratification for implantable cardioverter defibrillator therapies using cardiac magnetic resonance imaging: The importance of T1 mapping in nonischemic patients

Catheter Ablation at the Forefront: The Tribulations of Clinical Trials

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