Scar dechanneling: new method for scar-related left ventricular tachycardia substrate ablation
Antonio Berruezo1, Juan Fernández-Armenta2, David Andreu2
1From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain. berruezo@clinic.ub.es.
Insights
Scar dechanneling effectively treats ventricular tachycardia (VT) in over half of patients, reducing ablation extent and improving outcomes. Incomplete elimination of conducting channels (CCs) predicts recurrence, highlighting the importance of complete scar modification.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Device Technology
Background:
- Ventricular tachycardia (VT) substrate ablation often necessitates extensive procedures.
- The scar dechanneling technique offers a potentially less invasive approach to VT ablation.
Purpose of the Study:
- To evaluate the efficacy and outcomes of scar dechanneling for left ventricular scar-related VT.
- To compare outcomes between patients treated with scar dechanneling alone versus those requiring additional ablation.
Main Methods:
- Retrospective analysis of 101 patients with left ventricular scar-related VT undergoing ablation.
- Procedural endpoint: elimination of conducting channels (CCs) and abolition of inducible VTs.
- Comparison of outcomes based on whether scar dechanneling alone or combined with residual VT ablation was performed.
Main Results:
- Scar dechanneling alone achieved noninducibility in 54.5% of patients; combined ablation increased this to 78.2%.
- Patients treated with scar dechanneling alone had shorter procedures, fewer RF applications, and fewer shocks.
- At 2 years, scar dechanneling alone was associated with better event-free survival (80% vs. 62%) and lower mortality (5% vs. 11%).
- Incomplete CC-electrogram elimination was a significant predictor of recurrence.
Conclusions:
- Scar dechanneling alone is effective in a significant portion of patients, leading to low recurrence and mortality.
- While residual VT ablation improves acute results, patients requiring it experience worse long-term outcomes.
- Incomplete CC-electrogram elimination is the primary driver of VT recurrence after ablation.
Background:
Ventricular tachycardia (VT) substrate ablation usually requires extensive ablation. Scar dechanneling technique may limit the extent of ablation needed.
Methods And Results:
The study included 101 consecutive patients with left ventricular scar-related VT (75 ischemic patients; left ventricular ejection fraction, 36 ± 13%). Procedural end point was the elimination of all identified conducting channels (CCs) by ablation at the CC entrance followed by abolition of residual inducible VTs. By itself, scar dechanneling rendered noninducibility in 54.5% of patients; ablation of residual inducible VT increased noninducibility to 78.2%. Patients needing only scar dechanneling had a shorter procedure (213 ± 64 versus 244 ± 71 minutes; P = 0.027), fewer radiofrequency applications (19 ± 11% versus 27 ± 18%; P = 0.01), and external cardioversion/defibrillation shocks (20% versus 65.2%; P < 0.001). At 2 years, patients needing scar dechanneling alone had better event-free survival (80% versus 62%) and lower mortality (5% versus 11%). Incomplete CC-electrogram elimination was the only independent predictor (hazard ratio, 2.54 [1.06-6.10]) for the primary end point. Higher end point-free survival rates were observed in patients noninducible after scar dechanneling (log-rank P = 0.013) and those with complete CC-electrogram elimination (log-rank P = 0.013). The complications rate was 6.9%, with no deaths.
Conclusions:
Scar dechanneling alone results in low recurrence and mortality rates in more than half of patients despite the limited ablation extent required. Residual inducible VT ablation improves acute results, but patients who require it have worse outcomes. Recurrences are mainly related to incomplete CC-electrogram elimination.
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