Prognostic value of non-invasive programmed ventricular stimulation after VT ablation to predict VT recurrences

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• The prognostic value of programmed ventricular stimulation (PVS) and non-invasive programmed ventricular stimulation (NIPS) for predicting ventricular tachycardia (VT) recurrence post-ablation is debated.
• Optimal endpoints and timing for NIPS following VT ablation remain undefined.

Purpose of the Study:

• To evaluate the efficacy of PVS at the end of VT ablation and NIPS post-ablation in identifying patients at high risk for VT recurrence.
• To compare the predictive capabilities of PVS and NIPS for VT recurrence in patients with structural heart disease.

Main Methods:

• A cohort of 138 patients with VT and structural heart disease underwent first VT ablation and subsequent NIPS via implanted ICDs.
• NIPS was performed a median of 3 days post-ablation, assessing inducibility with extrastimuli.
• Patients were followed for a median of 37 months to determine VT recurrence rates.

Main Results:

• NIPS demonstrated higher positive predictive value (PPV: 65% vs. 46%) and negative predictive value (NPV: 68% vs. 61%) compared to PVS.
• Patients with inducible VT during NIPS exhibited significantly higher VT recurrence rates (66% vs. 29%) and mortality.
• NIPS showed the highest NPV in patients with ischemic cardiomyopathy (ICM) and ejection fraction > 35%.

Conclusions:

• NIPS performed 3 days post-VT ablation is superior to PVS for stratifying VT recurrence risk in patients with structural heart disease.
• NIPS provides more accurate prediction of VT recurrence, particularly in ICM patients, compared to PVS.
• Early re-ablation in patients with recurrent VT did not improve long-term outcomes.