Efecto del Marcapaseo Biventricular en la Recurrencia de Taquicardia Ventricular después de Ablación por Catéter

Biventricular (Bi-V) pacing improves left ventricular (LV) systolic function by correcting dyssynchrony, but potential proarrhythmic effects have been reported. The relationship between Bi-V pacing and ventricular tachycardia (VT) recurrence after catheter ablation (CA) remains unclear.

To assess the impact of Bi-V pacing on VT recurrence after CA in patients with structural heart disease, considering VT origin.

Out of 795 consecutive patients who underwent CA for VT, 384 met inclusion criteria of ≥90% Bi-V pacing (Bi-V pacing group) or intrinsic AV conduction with ≤10% ventricular pacing (Intrinsic Rhythm group). VT origin was classified as septal, lateral, and anterior/inferior. Baseline characteristics were balanced by propensity score matching (1:1) .

146 patients were included per group (median follow-up 473 days). All-cause mortality (26.0% vs. 24.7%, log-rank p=0.49) and heart failure hospitalization (21.9% vs. 21.9%, log-rank p=0.63) did not differ significantly between groups. VT/VF recurrence was higher in the Bi-V pacing group (37.0% vs. 19.2%, log-rank p<0.01) than in the intrinsic rhythm group and was largely due to greater VT recurrence in patients with lateral wall VT origins and Bi-V pacing (55.9% vs. 21.9% log-rank p<0.01). In the absence of Bi-V pacing a lateral wall VT origin was not associated with greater VT recurrences. On multivariable Cox regression, an LV lateral wall VT with Bi-V pacing was an independent predictor of VT recurrence (HR 3.04, 95% CI 1.65-5.60; p<0.01).

Bi-V pacing with an LV lateral wall substrate was associated with increased VT/VF recurrence after CA.