Matching Ablation Endpoints to Long-Term Outcome: The Prospective Multicenter Italian Ventricular...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Multicenter ventricular tachycardia (VT) ablation studies often report inferior outcomes compared to single-center experiences.
• Heterogeneous mapping and ablation strategies are suspected contributors to these outcome disparities.

Purpose of the Study:

• To evaluate a uniform, simplified catheter ablation strategy for VT across various substrates.
• To compare the efficacy of this standardized approach with results from a leading referral center.

Main Methods:

• A multicenter prospective registry enrolled 309 patients with VT secondary to myocardial infarction, myocarditis, arrhythmogenic right ventricular dysplasia, or idiopathic dilated cardiomyopathy.
• The protocol mandated precise mapping and ablation, targeting late potential (LP) abolition and VT noninducibility.
• The primary efficacy endpoint was long-term freedom from VT.

Main Results:

• Late potentials were present in 70% of patients and successfully abolished in 83%; 74% became noninducible post-procedure.
• The combined endpoint of LP abolition and noninducibility was met in 64% of patients with baseline LPs.
• Twelve-month freedom from VT was achieved in 67% of all patients; VT inducibility independently predicted recurrence.

Conclusions:

• A standardized VT mapping and ablation technique can replicate single-center outcomes in a multicenter setting.
• Achieving LP abolition and noninducibility significantly reduces VT recurrence across multiple cardiomyopathy types.