Ventricular Tachycardia Ablation Endpoints: Moving Beyond Noninducibility

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Catheter ablation is used for ventricular tachycardia (VT) in structural heart disease.
• Programmed electrical stimulation (PES) traditionally assesses acute success and predicts outcomes.
• Noninducibility via PES has suboptimal long-term VT freedom prediction and limitations.

Purpose of the Study:

• Critically appraise current and novel procedural endpoints for catheter ablation of scar-related VT.
• Evaluate the merits and limitations of different endpoints across various ablation techniques.
• Address the need for improved endpoints beyond PES noninducibility.

Main Methods:

• Review and critical appraisal of existing literature on procedural endpoints for VT ablation.
• Analysis of limitations of programmed electrical stimulation (PES).
• Evaluation of endpoints in substrate-based ablation approaches.

Main Results:

• Noninducibility by PES is validated but has suboptimal predictive performance for long-term VT freedom.
• PES is limited by antiarrhythmic drugs, anesthesia, and protocol variability.
• Substrate-based ablation necessitates additional endpoints beyond PES noninducibility.

Conclusions:

• Current endpoints for VT ablation, particularly PES noninducibility, require re-evaluation.
• Novel endpoints are crucial for optimizing catheter ablation strategies for scar-related VT.
• Further research is needed to establish superior procedural endpoints.