Ventricular tachycardia burden reduction after substrate ablation: Predictors of recurrence

Quinto, Levio; Sánchez-Somonte, Paula; Alarcón, Francisco; Garre, Paz; Castillo, A. del; Antonio, Rodolfo San; Borràs, Roger; Guasch, Eduard; Arbelo, Elena; Tolosana, José Marı́a; Berruezo, Antonio; Mont, Lluı́s; Roca‐Luque, Ivo

doi:10.1016/j.hrthm.2021.02.016

Cited by 27 publications

(18 citation statements)

References 20 publications

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“…Many studies have demonstrated that substrate ablation with the elimination of slow conduction areas (LAVAs, LPs, deceleration zones, etc.) is associated with better clinical outcomes ( 6 , 12 , 20 , 21 ). As stated before, the properties of the HD Grid Mapping Catheter, including the capability of orthogonal signal detection, as well as the use of a specific algorithm (HD Wave Solution), reduce variability in electrogram characteristics associated with differential orientations relative to the propagating wavefront and allow selection of the highest-amplitude signal in each location.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have demonstrated the relation of these electrograms, so-called late potentials (LPs) or local abnormal ventricular activity (LAVA), with VT ( 5 ). Indeed, many authors have suggested that complete elimination of the VT substrate results not only in tachycardia non-inducibility, but also results in fewer VT recurrences on long-term follow-up ( 1 , 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

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Orthogonal high-density mapping with ventricular tachycardia isthmus analysis vs. pure substrate ventricular tachycardia ablation: A case–control study

Vázquez-Calvo

Garre

Sánchez-Somonte

et al. 2022

Front. Cardiovasc. Med.

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BackgroundSubstrate-based ablation has become a successful technique for ventricular tachycardia (VT) ablation. High-density (HD) mapping catheters provide high-resolution electroanatomical maps and better discrimination of local abnormal electrograms. The HD Grid Mapping Catheter is an HD catheter with the ability to map orthogonal signals on top of conventional bipolar signals, which could provide better discrimination of the arrhythmic substrate. On the other hand, conventional mapping techniques, such as activation mapping, when possible, help to identify the isthmus of the tachycardia.AimThe purpose of this study was to compare clinical outcomes after using two different VT ablation strategies: one based on extensive mapping with the HD Grid Mapping Catheter, including VT isthmus analysis, and the other based on pure substrate ablation.MethodsForty consecutive patients undergoing VT ablation with extensive HD mapping method in the hospital clinic (November 2018–November 2019) were included. Clinical outcomes were compared with a historical cohort of 26 consecutive patients who underwent ablation using a scar dechanneling technique before 2018.ResultsThe density of mapping points was higher in the extensive mapping group (2370.24 ± 920.78 vs. 576.45 ± 294.46; p < 0.001). After 1 year of follow-up, VT recurred in 18.4% of patients in the extensive mapping group vs. 34.6% of patients in the historical control group (p = 0.14), with a significantly greater reduction of VT burden: VT episodes (81.7 ± 7.79 vs. 43.4 ± 19.9%, p < 0.05), antitachycardia pacing (99.45 ± 2.29 vs. 33.9 ± 102.5%, p < 0.001), and implantable cardioverter defibrillator (ICD) shocks (99 ± 4.5 vs. 64.7 ± 59.9%, p = 0.02).ConclusionThe use of a method based on extensive mapping with the HD Grid Mapping Catheter and VT isthmus analysis allows better discrimination of the arrhythmic substrate and could be associated with a greater decrease in VT burden.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Orthogonal high-density mapping with ventricular tachycardia isthmus analysis vs. pure substrate ventricular tachycardia ablation: A case–control study

Vázquez-Calvo

Garre

Sánchez-Somonte

et al. 2022

Front. Cardiovasc. Med.

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“…The term "recurrence" has been used to evaluate the outcome of the ablation therapy, however, recently the concept of a VT burden reduction has been proposed. 19,20 The VT burden can be more valuable in terms of clinical benefit than recurrence as a dichotomous event. In the present study, the VT burden was reduced by 91.1% even in patients in whom VT non-inducibility could not be achieved at the end of RF ablation, and VT ablation significantly reduced the number of VT episodes and shock therapies.…”

Section: Vt Burden Reductionmentioning

confidence: 99%

Predictors of VT recurrence in patients with VT inducibility at the end of radiofrequency ablation: Should we use VT non-inducibility as a routine endpoint?

Nakasone

Fukuzawa

Kiuchi

et al. 2021

Preprint

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Introduction: It has been reported that ventricular tachycardia (VT) non-inducibility at the end of ablation is associated with less likely VT recurrence. However, it is not clear whether we should use VT non-inducibility as routine end point in VT ablation. The aim of this study was to evaluate VT recurrence in patients in whom VT non-inducibility could not be achieved at the end of the RF ablation and the factors attributing to the VT recurrence. METHODS and RESULTS: We analyzed 84 consecutive patients that underwent RF ablation, and 64 patients in whom VT non-inducibility could not be achieved were studied. The primary endpoint was recurrence of any sustained VT during the follow-up. During a median follow-up period of 1.4 years (IQR:0.3-2.0), 22 (34%) of the cases had VT recurrences. In the multivariate analysis showed that an LVEF≥35% (HR:0.21; 95% CI:0.07- 0.54; P<0.01) and successful identification and ablation of all clinical VT isthmuses (HR:0.21; 95% CI:0.03- 0.72; P=0.01) were independent predictors of fewer VT recurrences. RF ablation was associated with a 91.1% reduction in VT episodes. CONCLUSION: Even if VT non-inducibility could not be achieved, the patients with LVEF≥35% or in whom all clinical VT isthmuses could successfully be identify and ablated might be prevented from having VT recurrences. The validity of VT non-inducibility of any VT should be evaluated by each patient’s background and the results of the procedure.

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“…Comparando la carga arrítmica pre y postablación exclusivamente de aquellos con al menos una recurrencia de taquicardia ventricular, la reducción de la carga fue del 69%, e igualmente se constataron reducciones significativas de choques apropiados y de episodios de tormenta arrítmica. La eliminación incompleta de potenciales tardíos aislados y la FEVI, fueron variables predictoras independientes de recurrencia 21 .…”

Section: Ablación Rfunclassified

Ablación y Neuromodulación en Tormenta Arrítmica. Serie de 4 casos y revisión de la literatura

Param¹,

Sáez

Salazar

et al. 2021

Rev Chil Cardiol

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Ventricular tachycardia burden reduction after substrate ablation: Predictors of recurrence

Cited by 27 publications

References 20 publications

Orthogonal high-density mapping with ventricular tachycardia isthmus analysis vs. pure substrate ventricular tachycardia ablation: A case–control study

Orthogonal high-density mapping with ventricular tachycardia isthmus analysis vs. pure substrate ventricular tachycardia ablation: A case–control study

Predictors of VT recurrence in patients with VT inducibility at the end of radiofrequency ablation: Should we use VT non-inducibility as a routine endpoint?

Ablación y Neuromodulación en Tormenta Arrítmica. Serie de 4 casos y revisión de la literatura

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