Long-term Outcome of Ventricular Tachycardia Ablation in Patients who did not Undergo Programmed Electrical Stimulation after Ablation

Abstract Background Magnetic resonance imaging and computed tomography in patients with ventricular tachycardia (VT) after myocardial infarction (MI) helps to delineate scar from healthy tissue. Image-guided VT ablation has not yet been studied on a large scale. Objective The aim of the meta-analysis was to compare the long-term outcome of image-guided VT ablation with a conventional approach for VT after MI. Methods Eight electronic bibliographic databases were searched to identify all relevant studies from 2012 until 2018. The search for scientific literature was performed for studies that described the outcome of VT ablation in patients with an ischaemic substrate. The outcome of image-guided ablation was compared with the outcome of conventional ablations. Results Of the 2990 citations reviewed for eligibility, 38 articles—enrolling a total of 7748 patients—were included into the meta-analysis. Five articles included patients with image-guided ablation. VT-free survival was 82% [74–90] in the image-guided VT ablation versus 59% [54–64] in the conventional ablation group (p < 0.001) during a mean follow-up of 35 months. Overall survival was 94% [90–98] in the image-guided versus 82% [76–88] in the conventional VT ablation group (p < 0.001). Conclusions Image-guided VT ablation in ischaemic VT was associated with a significant benefit in VT-free and overall survival as compared with conventional VT ablation. Visualising myocardial scar facilitates substrate-guided ablation procedures, pre-procedurally and by integrating imaging during the procedure, and may consequently improve long-term outcome.

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Long-Term Outcome Following Programmed Electrical Stimulation in Patients with High-Grade Ventricular Ectopy

Pacing and Clinical Electrophysiology ◽

10.1111/j.1540-8159.1988.tb04556.x ◽

1988 ◽

Vol 11 (5) ◽

pp. 603-609 ◽

Cited By ~ 10

Author(s):

MOHAMED H. KHARSA ◽

ROBERT L. GOLD ◽

HAROLD MOORE ◽

YOSHIZUMI YAZAKI ◽

CHARLES I. HAFFAJEE ◽

...

Keyword(s):

Electrical Stimulation ◽

High Grade ◽

Ventricular Ectopy ◽

Programmed Electrical Stimulation ◽

Term Outcome ◽

Long Term Outcome

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Long-term outcome and mode of recurrence following noninducibility during noninvasive programmed stimulation after ventricular tachycardia ablation

Pacing and Clinical Electrophysiology ◽

10.1111/pace.13605 ◽

2019 ◽

Vol 42 (3) ◽

pp. 333-340

Author(s):

Yasuhiro Shirai ◽

Jackson J. Liang ◽

Pasquale Santangeli ◽

Jeffrey S. Arkles ◽

Robert D. Schaller ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Term Outcome ◽

Long Term Outcome ◽

Ventricular Tachycardia Ablation ◽

Programmed Stimulation

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Ventricular tachycardia ablation in structural heart disease: Impact of ablation strategy and non-inducibility as an end-point on long term outcome

International Journal of Cardiology ◽

10.1016/j.ijcard.2018.08.099 ◽

2019 ◽

Vol 277 ◽

pp. 110-117 ◽

Cited By ~ 1

Author(s):

Alexander Breitenstein ◽

Vinit Sawhney ◽

Rui Providencia ◽

Shohreh Honarbakhsh ◽

Waqas Ullah ◽

...

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Structural Heart Disease ◽

Term Outcome ◽

Long Term Outcome ◽

Ventricular Tachycardia Ablation ◽

End Point ◽

Disease Impact

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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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Impact of a Chronic Total Occlusion in an Infarct-Related Artery on the Long-Term Outcome of Ventricular Tachycardia Ablation

Journal of Cardiovascular Electrophysiology ◽

10.1111/jce.12622 ◽

2015 ◽

Vol 26 (5) ◽

pp. 532-539 ◽

Cited By ~ 35

Author(s):

ANDREA DI MARCO ◽

GABRIELE PAGLINO ◽

TERESA OLORIZ ◽

GIUSEPPE MACCABELLI ◽

FRANCESCA BARATTO ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Chronic Total Occlusion ◽

Total Occlusion ◽

Term Outcome ◽

Long Term Outcome ◽

Ventricular Tachycardia Ablation ◽

Infarct Related Artery

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Abstract 16668: Long-term Outcomes After Endo-epicardial Catheter Ablation of Ventricular Tachycardia in Nonischemic Cardiomyopathy

Circulation ◽

10.1161/circ.132.suppl_3.16668 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Erica S Zado ◽

Pasquale Santangeli ◽

Francis E Marchlinski

Keyword(s):

Ventricular Tachycardia ◽

Catheter Ablation ◽

Substantial Improvement ◽

Nonischemic Cardiomyopathy ◽

Term Outcome ◽

Long Term Outcome ◽

Linear Ablation ◽

Long Term Follow Up

Introduction: Endo-epicardial catheter ablation of ventricular tachycardia (VT) in patients (pts) with nonischemic cardiomyopathy (NICM) has been reported to have satisfactory results at the short- and mid-term follow-up. We sought to determine the outcomes at the long-term follow-up of endo-epicardial ablation of VT in NICM. Hypothesis: Catheter ablation provides satisfactory long term outcome Methods: We prospectively enrolled 128 pts (age 59±13 years, 116 [91%] males) with NICM who underwent endo-epicardial radiofrequency catheter ablation at our Institution. After substrate mapping, all critical sites for the clinical or induced VT(s), identified with activation, entrainment or pace-mapping, together with late, split and fractionated potentials were targeted with focal and/or linear ablation. The procedural endpoint was noninducibility of sustained monomorphic VT. Pts were followed with ICD interrogation. Results: A total of 108 (73%) pts had idiopathic dilated NICM. The remaining 20 (14%) pts had hypertrophic CM (n=11), suspected inflammatory CM (n=6), or valvular CM (n=3). The mean LV ejection fraction was 33±15%. After a mean follow-up of 19 months (max 97 months), a total of 36 (28%) pts died and 17 (13%) underwent heart transplant. Cumulative survival free from any recurrent VT was 53% (68/128 patients) (Figure A). In the remaining 60 (47%) patients with VT recurrences, catheter ablation still resulted in a significant beneficial clinical impact on VT burden, with 25/60 (42%) having only isolated (1-2) VT episodes over follow-up, and a striking reduction of VT storm in the remaining pts (Figure B). Conclusions: In patients with NICM and VT, endo-epicardial substrate-based ablation is effective in achieving long-term freedom from any VT in 53% of patients, with a substantial improvement in VT burden in many of the remaining patients.

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