Impact of preventive substrate catheter ablation on implantable cardioverter-defibrillator interventions in patients...

Area of Science:

• Cardiology
• Electrophysiology
• Interventional Cardiology

Background:

• Ischaemic cardiomyopathy patients with coronary chronic total occlusion (CTO) face high risks of implantable cardioverter-defibrillator (ICD) therapy.
• Primary prevention ICD implantation is standard for these high-risk patients.

Purpose of the Study:

• To evaluate the efficacy of a preventive CTO-related substrate ablation strategy in ischaemic cardiomyopathy patients undergoing primary prevention ICD implantation.
• To assess the impact of this strategy on the occurrence of ICD therapy and related hospitalizations.

Main Methods:

• Prospective, multicentre, randomized trial (PREVENTIVE VT study) of ischaemic patients with ejection fraction ≤40% and CTO scar.
• Patients were randomized 1:1 to preventive substrate ablation before ICD implantation or standard ICD implantation only.
• Primary outcome: composite of appropriate ICD therapy or unplanned hospitalization for ventricular arrhythmias (VAs).

Main Results:

• The primary outcome occurred in 16.7% of patients with preventive ablation versus 43.3% with standard therapy (HR: 0.33; P = 0.037).
• Preventive ablation significantly reduced appropriate ICD therapies (P = 0.039) and electrical storms (P = 0.01).
• Cardiac hospitalizations were also reduced (P = 0.006), but cardiovascular mortality was not significantly impacted (P = 0.151).

Conclusions:

• Preventive ablation of CTO-related substrate in primary prevention ICD patients reduces the risk of appropriate ICD therapy and unplanned VA hospitalizations.
• This strategy offers a potential benefit for managing high-risk ischaemic cardiomyopathy patients.