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

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.

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Faculty Opinions recommendation of Long-term Outcomes of Ventricular Tachycardia Ablation in Different Types of Structural Heart Disease.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726122471.793533528 ◽

2017 ◽

Author(s):

Brian Olshansky

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Structural Heart Disease ◽

Long Term Outcomes ◽

Ventricular Tachycardia Ablation ◽

Different Types

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

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-020-00918-4 ◽

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.

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Long-Term Outcome After Ventricular Tachycardia Ablation in Nonischemic Cardiomyopathy

Circulation Arrhythmia and Electrophysiology ◽

10.1161/circep.119.008307 ◽

2020 ◽

Vol 13 (8) ◽

Author(s):

Kenji Okubo ◽

Lorenzo Gigli ◽

Nicola Trevisi ◽

Luca Foppoli ◽

Andrea Radinovic ◽

...

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Multivariable Analysis ◽

Structural Heart Disease ◽

Hazard Ratio ◽

Term Outcome ◽

Long Term Outcome ◽

Ventricular Tachycardia Ablation ◽

Vt Ablation

Background: In patients with an ischemic cardiomyopathy (ICM), the combination of late potential (LP) abolition and postprocedural ventricular tachycardia (VT) noninducibility is known to be the desirable end point for a successful long-term outcome after VT ablation. We investigated whether LP abolition and VT noninducibilty have a similar impact on the outcomes of patients with non-ICMs (NICM) undergoing VT ablation. Methods: A total of 403 patients with NICM (523 procedures) who underwent a VT ablation from 2010 to 2016 were included. The procedure end points were the LP abolition (if the LPs were absent, other ablation strategies were undertaken) and the VT noninducibilty. Results: The underlying structural heart disease consisted of dilated cardiomyopathy (DCM, 49%), arrhythmogenic right ventricular dysplasia (ARVD, 17%), postmyocarditis (14%), valvular heart disease (8%), congenital heart disease (2%), hypertrophic cardiomyopathy (2%), and others (5%). The epicardial access was performed in 57% of the patients. At baseline, the LPs were present in 60% of the patients and a VT was either inducible or sustained/incessant in 85% of the cases. At the end of the procedure, the LP abolition was achieved in 79% of the cases and VT noninducibility in 80%. After a multivariable analysis, the combination of LP abolition and VT noninducibilty was independently associated with free survival from VT (hazard ratio, 0.45 [95% CI, 0.29–0.69], P =0.0002) and cardiac death (hazard ratio, 0.38 [95% CI, 0.18–0.74], P =0.005). The benefit of the LP abolition on preventing the VT recurrence in patients with ARVD and postmyocarditis appeared superior to that observed for those with DCM. Conclusions: In patients with NICM undergoing VT ablation, the strategy of LP abolition and VT noninducibilty were associated with better outcomes in terms of long-term VT recurrences and cardiac survival. Graphic Abstract: A graphic abstract is available for this article.

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Long-term outcomes after catheter ablation of ventricular tachycardia in patients with and without structural heart disease

Heart Rhythm ◽

10.1016/j.hrthm.2016.07.001 ◽

2016 ◽

Vol 13 (10) ◽

pp. 1957-1963 ◽

Cited By ~ 68

Author(s):

Saurabh Kumar ◽

Jorge Romero ◽

Nishaki K. Mehta ◽

Akira Fujii ◽

Sunil Kapur ◽

...

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Catheter Ablation ◽

Structural Heart Disease ◽

Long Term Outcomes

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Faculty Opinions recommendation of Long-term outcomes after catheter ablation of ventricular tachycardia in patients with and without structural heart disease.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726491738.793533548 ◽

2017 ◽

Author(s):

Brian Olshansky

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Catheter Ablation ◽

Structural Heart Disease ◽

Long Term Outcomes

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Catheter Ablation for Ventricular Tachycardia in Patients with Structural Heart Disease

US Cardiology Review ◽

10.15420/usc.2017:28:3 ◽

2018 ◽

Vol 12 (1) ◽

pp. 51-56 ◽

Cited By ~ 2

Author(s):

Timothy M Markman ◽

Daniel A McBride ◽

Jackson J Liang

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Catheter Ablation ◽

Structural Heart Disease ◽

Integrated Approach ◽

Implantable Cardioverter Defibrillators ◽

Therapeutic Modalities ◽

Fatal Arrhythmia ◽

Term Management

Ventricular tachycardia is a potentially fatal arrhythmia that occurs most frequently in patients with structural heart disease. Acute and long- term management can be complex, requiring an integrated approach with multiple therapeutic modalities including antiarrhythmic drugs, implantable cardioverter defibrillators, and catheter ablation. Each of these options has a role in management of ventricular tachycardia and are generally used in combination. It is essential to be aware that each approach has potential deleterious consequences that must be balanced while establishing a treatment strategy. Catheter ablation for ventricular tachycardia is performed with increasing frequency with rapidly evolving techniques. In this review, we discuss the acute and long-term management of ventricular tachycardia with a focus on techniques and evidence for catheter ablation.

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Substrate Characterization and Outcomes of Ventricular Tachycardia Ablation in Titin Cardiomyopathy: A Multicenter Study

Circulation Arrhythmia and Electrophysiology ◽

10.1161/circep.121.010006 ◽

2021 ◽

Author(s):

Andres Enriquez ◽

Jackson Liang ◽

Jeffrey Smietana ◽

Daniele Muser ◽

Pablo Salazar ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Electrical Storm ◽

Circulatory Support ◽

Long Term Outcomes ◽

Bundle Branch Block ◽

Ventricular Tachycardia Ablation ◽

Increased Risk ◽

Arrhythmogenic Substrate ◽

Vt Ablation

Background - Truncating variants of the titin gene (TTNtv) are a leading cause of dilated cardiomyopathy (DCM) and have been associated with an increased risk of ventricular arrhythmias. This study evaluated the substrate distribution and the acute and long-term outcomes of patients with TTN-related cardiomyopathy undergoing ventricular tachycardia (VT) ablation. Methods - This multicenter registry included 15 patients with DCM (age 59±11 years, 93% male, ejection fraction 30±12%) and genotypically confirmed TTNtvs who underwent VT ablation between July 2014 and July 2020. Results - All patients presented with sustained monomorphic VT, including electrical storm in 4 of them. A median of 2 VTs per patient were induced during the procedure (cycle-length 318±68 ms) and the predominant morphologies were left bundle branch block with inferior axis (39%) and right bundle branch block with inferior axis (29%). A complete map of the left ventricle (LV) was created in 12 patients and showed voltage abnormalities mainly at the periaortic (92%) and basal septal region (58%). A preprocedural cardiac magnetic resonance imaging was available in 13 patients and in 11 there was evidence of LV delayed gadolinium enhancement, with predominantly midmyocardial distribution. Sequential ablation from both sides of the septum was required in 47% of patients to target septal intramural substrate and epicardial ablation was performed in 20%. At the end of the procedure, the clinical VT was noninducible in all patients, while in 3 cases a non-clinical VT was still inducible. After a follow-up of 26.5±23.0 months, 53% of patients experienced VT recurrence, 20% received transplant or mechanical circulatory support and 7% died. Conclusion - The arrhythmogenic substrate in TTN-related cardiomyopathy involves the basal septal and perivalvular regions. Long-term outcomes of catheter ablation are modest, with high recurrence rate, likely related to an intramural location of VT circuits.

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