Noninducibility After Ablation of Post-Infarct Ventricular Tachycardia | Journal Scan

May 05, 2015
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Authors:
Yokokawa M, Kim HM, Baser K, et al.
Citation:
Predictive Value of Programmed Ventricular Stimulation After Catheter Ablation of Post-Infarction Ventricular Tachycardia. J Am Coll Cardiol 2015;65:1954-1959.
Summary By:
Thomas C. Crawford, MD, FACC

Study Questions:

Is noninducibility after ventricular tachycardia (VT) ablation associated with improved survival?

Methods:

A retrospective analysis was performed on 1,064 patients who had undergone VT ablation for post-infarction VT at seven international centers. The ablation procedure was considered successful if no VT was inducible at the end of the procedure, and unsuccessful if VT remained inducible or if programmed stimulation was not performed at the end of the ablation.

Results:

Median follow-up time was 633 days. Noninducibility was independently associated with lower mortality (adjusted hazard ratio, 0.65; 95% confidence interval, 0.53-0.79; p < 0.001). Atrial fibrillation, diabetes, and age were other independent predictors of higher mortality (heart failure class was not). Ablation of only the clinical VT in patients who also had inducible, nonclinical VTs was not associated with improved survival.

Conclusions:

The authors concluded that noninducibility after VT ablation in patients with post-infarction VT is independently associated with lower mortality during long-term follow-up.

Perspective:

Most patients with a history of myocardial infarction who present for VT ablation have scars containing multiple isthmuses capable of producing multiple morphologies of VT. During electrophysiologic procedures to eliminate VT, one approach has been to identify the clinical VT (i.e., the VT morphology), which resulted in ICD therapies, and to target the circuit responsible for this VT. The value of targeting all inducible VT morphologies has been controversial. The present study, while retrospective and observational, suggests that elimination of all inducible VTs is associated with improved survival. Ablation of only the clinical VT was not associated with either a reduction in mortality or in recurrent VT. If confirmed in prospective randomized trials, this finding could have a significant impact on VT ablations, and make what is an already long procedure so much longer.

Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Catheter Ablation, Diabetes Mellitus, Electrophysiology, Follow-Up Studies, Heart Failure, Infarction, Mortality, Myocardial Infarction, Tachycardia, Tachycardia, Ventricular


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