333 Substrate modification in ischaemic cardiomyopathy to treat ventricular tachycardia using electroanatomic scar mapping

EP Europace ◽  
2005 ◽  
Vol 7 ◽  
pp. 101-102
Keyword(s):  
Ventricular Tachycardia ◽  
Ischaemic Cardiomyopathy ◽  
Substrate Modification

333 Substrate modification in ischaemic cardiomyopathy to treat ventricular tachycardia using electroanatomic scar mapping

EP Europace ◽  
2005 ◽  
Vol 7 (Supplement_1) ◽  
pp. 101-102
Author(s):  
T. Deneke ◽  
B. Lemke ◽  
T. Lawo ◽  
B. Calcum ◽  
A. Muegge ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Ischaemic Cardiomyopathy ◽  
Substrate Modification

Post-MI VT

2017 ◽  
Author(s):  
Hein Heidbuchel ◽  
Mattias Duytschaever ◽  
Haran Burri
Keyword(s):  
Myocardial Infarction ◽  
Ventricular Tachycardia ◽  
Post Myocardial Infarction ◽  
Substrate Modification

This case discusses substrate modification for post-myocardial infarction ventricular tachycardia

scholarly journals Substrate modification or ventricular tachycardia induction, mapping, and ablation as the first step? A randomized study

Heart Rhythm ◽  
2016 ◽  
Vol 13 (8) ◽  
pp. 1589-1595 ◽  
Author(s):  
Juan Fernández-Armenta ◽  
Diego Penela ◽  
Juan Acosta ◽  
David Andreu ◽  
Reinder Evertz ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Randomized Study ◽  
Substrate Modification

P3816Cost-effectiveness of ventricular tachycardia catheter ablation: limitations in the current trial evidence base

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Chen ◽  
M Gomes ◽  
J V Garcia ◽  
P D Lambiase
Keyword(s):  
Ventricular Tachycardia ◽  
Cost Effectiveness ◽  
Catheter Ablation ◽  
Markov Model ◽  
Time Horizon ◽  
Cost Effective ◽  
Life Assessment ◽  
System Level ◽  
Ischaemic Cardiomyopathy ◽  
Trial Evidence

Abstract Introduction Randomised clinical trials (RCTs) have suffered from criticisms including a lack of generalisability as well as a lack of cost-effectiveness analysis of the different interventions being studied. Such analyses are used by organisations including the UK's National institute for Health and Care Excellence (NICE) to inform system-level decisions regarding which treatments are funded. There is the potential for a growing chasm to exist between what is the latest innovation in cardiology and what can be afforded. Purpose To evaluate the cost-effectiveness of ventricular tachycardia (VT) catheter ablation versus anti-arrhythmic drug (AAD) therapy in ischemic heart disease. Methods A decision-analytic Markov model was used to calculate the costs and health outcomes of catheter ablation or AAD treatment of VT for a hypothetical cohort of patients with ischaemic cardiomyopathy andan implantable cardioverter defibrillator (ICD). Model inputs where informed using RCT-level evidence [Table 1] wherever possible. Costs were calculated from a UK perspective. Results Catheter ablation vs. AAD therapy had an incremental cost-effectiveness ratio (ICER) of £144,150 (€161,448) per quality adjusted life year (QALY) gained, over a five-year time horizon. The ICER for a ten-year time horizon was £75,074 (€84,083) and £69,986 (€78,384) over the cohort's lifetime. Using probabilistic sensitivity analyses to account for model parameter uncertainty, the likelihood of catheter ablation being cost-effective was only 11%, assuming a willingness to pay threshold of £30,000 used by the NICE [Figure 1]. Table 1. Summary of RCT level source data used to inform Markov model inputs Name of trial SMASH VT VTACH SMS CALYPSO VANISH VISTA Sample size 128 110 111 27 259 118 Mean age 67 66 67 64 68 66 Control AAD AAD AAD AAD AAD Clinical ablation Intervention Ablation Ablation Ablation Ablation Ablation Substrate ablation Length of follow up 22 months 24 months 28 months 6 months 28 months 12 months Mortality (%) 11% [AAD] 7% [AAD] 19% [AAD] 14% [AAD] 28% [AAD] 15% [C-ablation] vs. vs. vs. vs. vs. vs. 9% [Ablation] 10% [Ablation] 17% [Ablation] 15% [Ablation] 27% [Ablation] 9% [S-Ablation] Readmission (%) 19% [AAD] 55% [AAD] 44% [AAD] 50% [AAD] 31% [AAD] 32% [C-ablation] vs. vs. vs. vs. vs. vs. 12% [S-ablation] 6% [Ablation] 33% [Ablation] 39% [Ablation] 38% [Ablation] 25% [Ablation] Cost-effectiveness acceptability curve Conclusion Catheter ablation of VT is unlikely to be cost-effective compared with AAD therapy alone in patients with ischaemic cardiomyopathy implanted with an ICD based on pooled trial evidence. However, better designed studies incorporating detailed and more frequent quality of life assessment are needed to advise health policy in this field and to provide more informed cost-effectiveness analyses. Acknowledgement/Funding NIHR Academic Clinical Fellowship

Abstract 4090: Substrate Modification Using Electroanatomically-guided Linear Ablation During Sinus Rhythm To Treat Post-infarction Ventricular Tachycardia

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Thomas Deneke ◽  
Bernd Lemke ◽  
Leif-Ilja Boesche ◽  
Bernd Calcum ◽  
Andreas Muegge ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Ventricular Arrhythmia ◽  
Sinus Rhythm ◽  
Border Zone ◽  
Ablation Procedure ◽  
Substrate Modification ◽  
Linear Ablation ◽  
Partial Success

Catheter ablation of ventricular tachycardia (VT) in the setting of ischemic cardiomyopathy can be performed to modify the underlying substrate. We evaluated the efficacy of a linear VT ablation procedure based on sinus rhythm (SR) substrate maps to treat ischemic VT in consecutive patients. Methods: In 110 consecutive patients with ischemic VT (56% not tolerated) catheter ablation was attempted. During SR left ventricular scar mapping was performed identifying scar tissue (bipolar voltages 1.5mV). Regionalization of VT-exit regions was performed based on pace-mapping within the scar border zone. Ablation was directed towards the identified exit region performing linear ablation along the scar border. ICD-holter interrogation was performed during follow-up. Results: A mean of 2.7±1.6 different VTs were inducible per patient (total 286). In 97% (107) of all patients (74% of all inducible VTs ablated: 213/286) the clinical VT was successfully ablated. In 68 patients (62%) no sustained monomorphic VT (complete success) was inducible at the end of the ablation procedure whereas in 39 patients (35%) VTs (partial success) were still inducible. Over a median follow-up of 12 months (6 –39) 88 (80%) patients were free from any ventricular arrhythmia. 19 successfully ablated patients had recurrences in between 6 to 36 months post intervention but the number of episodes treated by the ICD was significantly reduced (16±4 within 3 months (3±2) (p=0.02). No difference in patients with tolerated compared to non-tolerated VTs were detected (recurrences in 7/48 (15%) tolerated and 15/62 (24%) non-tolerated; p=0.13). There was a significant difference in freedom from any VT in patients with complete (88%) versus partial success (72%) (p=0.04). Conclusions: Substrate modification targeting only the scar-border zone including the VT exit site based on SR-maps is highly effective in suppressing the occurrence of a clinical VT in patients with remote myocardial infarction (97%). Based on the electro-anatomical findings complete freedom from any ventricular arrhythmia over a median of 1 year can be achieved in 80% of all patients. No difference in regard to freedom from any ventricular arrhythmia can be documented in patients with tolerated and non-tolerated VTs.

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