Efficacy of catheter ablation for ventricular tachycardia in ischemic cardiomyopathy patients without an ICD
Le Li1, Ligang Ding1, Lingmin Wu1
1Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Heart Rhythm
|May 11, 2024
Summary
Catheter ablation for ventricular tachycardia (VT) in ischemic cardiomyopathy (ICM) patients without an implantable cardioverter-defibrillator (ICD) showed a low rate of fatal outcomes. Most VT recurrences were not life-threatening, suggesting ablation is a viable option.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Implantable cardioverter-defibrillators (ICDs) prevent sudden cardiac death in ischemic cardiomyopathy (ICM).
- Catheter ablation effectively reduces ventricular tachycardia (VT) recurrence, but its use without an ICD is less understood.
Purpose of the Study:
- To assess the outcomes of catheter ablation for VT in ICM patients who have not received an ICD.
Main Methods:
- 114 ICM patients undergoing VT ablation without an ICD were studied.
- Ablation strategies included activation or substrate mapping, with endocardial ablation as the primary approach and epicardial access if needed.
- Primary endpoint was VT recurrence; secondary endpoints included rehospitalization and mortality.
Main Results:
- VT recurred in 39.5% of patients over a median follow-up of 53.8 months.
- Endo-epicardial ablation was associated with a significantly lower VT recurrence rate (8.3%) compared to endocardial ablation alone (43.1%).
- Epicardial ablation independently reduced the risk of VT recurrence (HR 0.14; P = .048).
Conclusions:
- VT ablation in ICM patients without an ICD resulted in a low rate of arrhythmic death.
- The majority of VT recurrences observed were non-lethal.
