Long-term results after ablation of infarct-related ventricular tachycardia
Oliver R Segal1, Anthony W C Chow, Vias Markides
1St. Mary's Hospital and Imperial College of Medicine, London, United Kingdom.
Insights
Catheter ablation effectively reduces implantable cardioverter-defibrillator (ICD) therapy for infarct-related ventricular tachycardia (VT). However, recurrence remains common, indicating ablation is adjunctive, not a substitute for ICDs.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Long-term outcomes of catheter ablation for infarct-related ventricular tachycardia (VT) are not well-defined.
- Understanding the necessity and efficacy of implantable cardioverter-defibrillator (ICD) therapy post-ablation is crucial.
Purpose of the Study:
- To evaluate the long-term effectiveness of catheter ablation in treating infarct-related VT.
- To assess the subsequent need for ICD therapy after successful VT ablation.
Main Methods:
- Utilized noncontact mapping to guide catheter ablation in 40 patients with infarct-related VT.
- Mapped 140 VTs, targeting 81 for ablation, and monitored patients for recurrence and ICD shocks.
Main Results:
- Achieved a high procedural success rate for VT ablation (82.7%), significantly reducing ICD shock frequency (from 6.8 to 0.05 shocks/month).
- VT recurrence occurred in 7.5% of patients, with 37.5% experiencing new or recurrent VT/ventricular fibrillation (VF).
- Only 42.5% of patients remained free from VT/VF at 3 years post-ablation.
Conclusions:
- Noncontact mapping-guided VT ablation offers high success rates and reduces ICD therapy needs for infarct-related VT.
- Catheter ablation serves as an important adjunctive therapy for symptomatic VT but does not replace ICDs or antiarrhythmic drugs.
- Long-term VT/VF recurrence highlights the continued role of ICDs and medical management in these patients.
Objectives:
The purpose of this study was to assess the long-term effects of ablation of infarct-related ventricular tachycardia (VT) and the subsequent requirement for implantable cardioverter-defibrillator (ICD) therapy.
Background:
The long-term consequences after initially successful catheter ablation of infarct-related VT remain unclear.
Methods:
Forty patients who presented with infarct-related VT were studied using noncontact mapping to guide ablation.
Results:
One hundred forty VTs were mapped using the noncontact mapping system, including 36 (25.7%) clinical VTs. An endocardial exit site was determined in 100% of VT circuits, diastolic endocardial activity in 77 VTs (55%), and complete circuits in 24 VTs (17.1%). Eighty-one VTs (57.9%) were targeted for ablation, of which 67 (82.7% of targeted) were successfully ablated, including 27 clinical VTs (75% of clinical). Documented recurrence of an ablated VT occurred in 7.5% of patients over 36.3 +/- 21.0 months of follow-up. Episodes of new or recurrent, nontargeted VT or ventricular fibrillation (VF) occurred in 37.5% and VT recurrence without documentation of cycle length in 5%. In patients with ICDs, mean shock frequency was reduced from 6.8 +/- 7.3 per month in the year prior to ablation to 0.05 +/- 0.12 per month after ablation, over 24.7 +/- 18.9 months of follow-up (P < .0001).
Conclusions:
In patients with infarct-related VT, noncontact mapping-guided VT ablation is associated with a high procedural success rate, and VT recurrence necessitating ICD therapy delivery is significantly reduced. However, only 42.5% of patients remain free from VT/VF 3 years after ablation. Catheter ablation for infarct-related VT is indicated as an adjunctive therapy in patients with symptomatic VT but cannot substitute for ICDs and antiarrhythmic drugs.
More Related Videos
10:46Non-fluoroscopic Catheter Tracking for Fluoroscopy Reduction in Interventional Electrophysiology
Published on: May 26, 2015
12:45Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
