P1125 Safety and efficacy of ventricular tachycardia ablation during sinus rhythm in patients with structural heart disease

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
J Fernandez-Armenta Pastor ◽  
E Silva ◽  
D Soto-Iglesias ◽  
D Penela ◽  
J Acosta ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ventricular Tachycardia ◽  
Sinus Rhythm ◽  
Structural Heart Disease ◽  
Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Arrhythmogenic Substrate ◽  
Vt Ablation ◽  
One Year ◽  
Multicenter Registry

Abstract Funding Acknowledgements Project “PI-0057-2017”, funded by Junta de Andalucía and co-funded by European Union (ERDF/ESF, “Invesing in your future”) Background The best strategy for scar related ventricular tachycardia (VT) ablation is not yet established. Recently, the use of ventricular assist devices is being proposed to allow ablation during unstable VT.  Purpose Analyze the results of a multicenter registry of substrate-guided VT ablation performed primarily during stable rhythm. Methods  This prospective multicenter registry included 433 VT ablation procedures performed in 372 consecutive patients with structural heart disease undergoing VT ablation. Substrate ablation (scar dechanneling technique) during sinus rhythm without initial VT induction was the standard protocol. Any episode of sustained VT or appropriate ICD therapy was considered VT recurrence.  Results  Myocardial infarction was the arrhythmogenic substrate in 64% of patients. 90.5% of patients were male, mean age 64 ± 13 years. Mean LVEF was 38 ± 13%.No ventricular assist device was used in any case. After substrate ablation no VT was inducible in 69% of cases. End-procedure non-inducibility was achieved in 73.1% of cases. Complication rate was 6.7 %. 30-days mortality was 1.9% (7 patients), including one procedure related death. At one year after first procedure 17 patients died (4.5%). Age, chronic obstructive pulmonary disease and renal failure were independent predictors of mortality. One-year freedom from VT recurrence was 84%.  Conclusion Substrate-guided VT ablation during stable rhythm as main approach for scar-related VT treatment is associated to low complication and recurrence rates in this prospective multicenter study.

scholarly journals Long-term Outcomes of Ventricular Tachycardia Ablation in Different Types of Structural Heart Disease

2015 ◽  
Vol 4 (3) ◽  
pp. 177 ◽  
Author(s):  
Jackson J Liang ◽  
Pasquale Santangeli ◽  
David J Callans ◽  
◽  
◽  
...  
Keyword(s):  
Heart Disease ◽  
Ventricular Tachycardia ◽  
Structural Heart Disease ◽  
Implantable Cardioverter Defibrillators ◽  
Mortality Benefit ◽  
Long Term Outcomes ◽  
Ventricular Tachycardia Ablation ◽  
Different Types ◽  
Vt Ablation

Ventricular tachycardia (VT) often occurs in the setting of structural heart disease and can affect patients with ischaemic or nonischaemic cardiomyopathies. Implantable cardioverter-defibrillators (ICDs) provide mortality benefit and are therefore indicated for secondary prevention in patients with sustained VT, but they do not reduce arrhythmia burden. ICD shocks are associated with increased morbidity and mortality, and antiarrhythmic medications are often used to prevent recurrent episodes. Catheter ablation is an effective treatment option for patients with VT in the setting of structural heart disease and, when successful, can reduce the number of ICD shocks. However, whether VT ablation results in a mortality benefit remains unclear. We aim to review the long-term outcomes in patients with different types of structural heart disease treated with VT ablation.

Outcomes after repeat ablation of ventricular tachycardia in structural heart disease: An analysis from the International VT Ablation Center Collaborative Group

Heart Rhythm ◽  
2017 ◽  
Vol 14 (7) ◽  
pp. 991-997 ◽  
Author(s):  
Wendy S. Tzou ◽  
Roderick Tung ◽  
David S. Frankel ◽  
Luigi Di Biase ◽  
Pasquale Santangeli ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ventricular Tachycardia ◽  
Structural Heart Disease ◽  
Collaborative Group ◽  
Vt Ablation

Abstract 18718: Trends, Predictors, and Regional Variation in Use of Catheter Ablation Among 184,443 Hospitalizations for Ventricular Tachycardia

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Wendy S Tzou ◽  
David F Katz ◽  
Ryan G Aleong ◽  
William H Sauer ◽  
David P Kao
Keyword(s):  
New York ◽  
Heart Disease ◽  
Ventricular Tachycardia ◽  
New Jersey ◽  
Structural Heart Disease ◽  
Patient Characteristics ◽  
Discharge Data ◽  
Hospitalization Rates ◽  
Vt Ablation ◽  
White Patients

Introduction: Catheter radiofrequency ablation (RFA) is used increasingly for treatment of ventricular tachycardia (VT), but little is known about utilization patterns. Hypothesis: Regional trends in VT hospitalization and RFA,and patient characteristics associated with VT RFA vary. Methods: Hospital discharge data was obtained from state agencies in California, New York, New Jersey, Vermont, New Hampshire, West Virginia, Colorado, and Texas from 1994-2012. All records with primary diagnosis of VT (ICD9-CM 427.1) were analyzed. Population-adjusted hospitalization rates were estimated using US Census Bureau data. In hospitals performing VT RFA, patient characteristics associated with RFA were identified using multivariate logistic regression. Results: In total, 184,443 hospitalizations for VT were reported; 11,941/136,437 (8.8%) admitted to VT ablation hospitals underwent RFA. Annual VT hospitalization rates varied from 10-17/100,000 in California (CA) and Texas (TX) to 20-30 in New York and New Jersey (NJ). VT ablation/hospitalization frequency varied from 9% in NJ to 18% in CA and TX. Positive predictors of undergoing VT RFA were female gender, non-white race, admission from home, and atrial flutter. Negative predictors included advancing age, non-private insurance, atrial fibrillation, anemia, coronary artery disease, heart failure, hypertension, and shock on admission (Figure, A). Higher RFA rates for women were driven by more patients without structural heart disease compared to men (Figure, B). Non-white patients were more likely to undergo RFA irrespective of structural heart disease. Conclusion: Significant regional variations exist in VT hospitalization and ablation rates. Also of note, women and non-white patients were more likely to undergo ablation, which may have reflected important differences in cardiac disease substrate.

scholarly journals Impact of a high-density grid catheter on long-term outcomes for structural heart disease ventricular tachycardia ablation

2021 ◽  
Author(s):  
Riccardo Proietti ◽  
Rory Dowd ◽  
Lim Ven Gee ◽  
Shamil Yusuf ◽  
Sandeep Panikker ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ventricular Tachycardia ◽  
Structural Heart Disease ◽  
High Density ◽  
Long Term Outcomes ◽  
Density Mapping ◽  
Significant Difference ◽  
Vt Ablation ◽  
Mapping Catheter

Abstract Background Substrate mapping has highlighted the importance of targeting diastolic conduction channels and late potentials during ventricular tachycardia (VT) ablation. State-of-the-art multipolar mapping catheters have enhanced mapping capabilities. The purpose of this study was to investigate whether long-term outcomes were improved with the use of a HD Grid mapping catheter combining complementary mapping strategies in patients with structural heart disease VT. Methods Consecutive patients underwent VT ablation assigned to either HD Grid, Pentaray, Duodeca, or point-by-point (PbyP) RF mapping catheters. Clinical endpoints included recurrent anti-tachycardia pacing (ATP), appropriate shock, asymptomatic non-sustained VT, or all-cause death. Results Seventy-three procedures were performed (33 HD Grid, 22 Pentaray, 12 Duodeca, and 6 PbyP) with no significant difference in baseline characteristics. Substrate mapping was performed in 97% of cases. Activation maps were generated in 82% of HD Grid cases (Pentaray 64%; Duodeca 92%; PbyP 33% (p = 0.025)) with similar trends in entrainment and pace mapping. Elimination of all VTs occurred in 79% of HD Grid cases (Pentaray 55%; Duodeca 83%; PbyP 33% (p = 0.04)). With a mean follow-up of 372 ± 234 days, freedom from recurrent ATP and shock was 97% and 100% respectively in the HD Grid group (Pentaray 64%, 82%; Duodeca 58%, 83%; PbyP 33%, 33% (log rank p = 0.0042, p = 0.0002)). Conclusions This study highlights a step-wise improvement in survival free from ICD therapies as the density of mapping capability increases. By using a high-density mapping catheter and combining complementary mapping strategies in a strict procedural workflow, long-term clinical outcomes are improved.

Abstract 18662: Ablation of Regions of Very Slow Conduction Within a Myocardial Scar and Recurrence of Ventricular Tachycardia After Catheter Ablation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Asad A Aboud ◽  
M. Benjamin Shoemaker ◽  
Pablo Saavedra ◽  
Juan C Estrada ◽  
Sharon Shen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ventricular Tachycardia ◽  
Sinus Rhythm ◽  
Structural Heart Disease ◽  
Myocardial Scar ◽  
Activation Time ◽  
Substrate Modification ◽  
Slow Conduction ◽  
Vt Ablation

Background: It has been established that areas of slow conduction within a myocardial scar identified by isochronal mapping during sinus rhythm harbor the functional substrate that is involved in sustaining ventricular tachycardia (VT). We sought to test the hypothesis that targeting the region of slowest conduction during sinus rhythm would reduce VT recurrence following ablation. Methods and Results: 32 subjects underwent ablation for sustained monomorphic VT associated with structural heart disease from 2013 to 2014. Sustained VT recurred in 12 patients (37.5%). Isochronal late activation maps were created to display activation during sinus rhythm in the region of bipolar scar. The scar was divided into three zones of equal activation time. The zone with the densest isochrones was designated as having the slowest conduction . We retrospectively analyzed isochronal maps and measured the proportion of the slowest zone that was ablated (median 14%, IQR 0-50). During a mean follow-up of 6 months, recurrence of ventricular arrhythmia was significantly associated with ablation of the slowest zone (OR 0.126, CI 0.024-0.68, p 0.016). Furthermore, univariate logistic regression demonstrated reduction of 30% in the 6-month VT recurrence rate for every 10% increase in percent of the slowest zone ablated (OR 0.7, 95% CI 0.5-1.0, p=0.05). Conclusions: Patients who had ablation in the region of slowest conduction were significantly less likely to have recurrence of ventricular tachycardia. Our data suggests a strategy to target the slowest region of conduction for substrate modification may hold promise for improving outcomes of scar-mediated VT ablation.

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