The impact of previous VT substrate radiofrequency catheter ablation procedures for patients presenting with...

Ventricular tachycardias (VT) that appear after catheter ablation (RFA) may respond poorly to conservative treatment and increase mortality. Current evidence favors repeating RFA to reduce VT-burden and improve outcomes if recurrences are precluded. This has not exclusively been studied in electrical storm patients.

We sought to compare patient/procedural characteristics and long-term all-cause mortality and recurrences in single-RFA versus repeat-RFA patients.

This was a retrospective single-center analysis of consecutive electrical storm patients treated by RFA monitored for a mean of 32.8 (range 10-68) months. Inducibility of sustained monomorphic VT was assessed by programmed ventricular stimulation. We assessed differences in patient/procedural characteristics and compared all-cause mortality and recurrences in single-RFA versus repeat-RFA during the first year post-ablation.

In total, 101 patients (mean age 59.69 [12.8] years, 32.7% non-ischemic cardiomyopathies, 34 cases of repeat-RFA) were included. Compared to single-RFA, repeat-RFA patients more frequently had non-ischemic cardiomyopathies (47.1% vs. 26.9%; P = 0.04), required more epicardial ablation (32.4% vs. 14.9%; P = 0.04), and more frequently had epicardial-access complications (14.8% vs. 1.6%; P = 0.02). All-cause mortality (repeat-RFA 10 deaths [29.4%] vs. single-RFA 21 deaths [31.3%]; P = 0.99) and recurrences (repeat-RFA 13 recurrences [38.2%] vs. single-RFA 23 recurrences [34.3%]; P = 0.82) were comparable during follow-up. All-cause mortality (log rank P = 0.62) and recurrences (log-rank P = 0.65) were similar in repeat-RFA vs. single-RFA during the first year after ablation.

Despite requiring more epicardial ablation and more non-ischemic myocardial substrate, repeat-RFA patients showed similar all-cause mortality and recurrences compared to single-RFA during the first year post-ablation.