Outcome of ventricular tachycardia catheter ablation in ischemic heart disease patients using a high-density mapping substrate-based approach: A prospective cohort study

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Ventricular tachycardia (VT) in ischemic heart disease (IHD) poses significant risks, including VT storm and implantable cardioverter defibrillator (ICD) shocks.
• Radiofrequency catheter ablation (RCA) is an established treatment, but outcomes with high-density substrate-based approaches require further elucidation.

Purpose of the Study:

• To evaluate the efficacy and safety of a single radiofrequency catheter ablation (RCA) procedure for ventricular tachycardia (VT) in patients with ischemic heart disease (IHD).
• To assess the impact of a high-density substrate-based mapping approach on VT recurrence, VT storm, ICD shocks, and overall mortality.

Main Methods:

• A prospective, observational, single-center study involving 64 patients with IHD undergoing RCA for VT.
• High-density mapping was used to identify and eliminate local abnormal ventricular activities (LAVAs), with VT non-inducibility as a procedural endpoint.
• Primary endpoint was survival free from appropriate ICD shocks; secondary endpoints included VT storm and all-cause mortality.

Main Results:

• High-density mapping identified LAVAs in all patients, with 83% exhibiting inducible VT.
• Successful LAVA elimination was achieved in 93.8%, and VT non-inducibility in 60% of patients.
• At two years, 85% of patients were free from appropriate ICD shocks, and VT storm incidence decreased from 39% to 1.6%.

Conclusions:

• A high-density substrate-based radiofrequency catheter ablation (RCA) approach for ventricular tachycardia (VT) in ischemic heart disease (IHD) patients leads to sustained freedom from ICD shocks and VT storm.
• This method offers a promising therapeutic strategy for managing complex VT in this patient population.