Noninducibility and late potential abolition: a novel combined prognostic procedural end point for catheter ablation of postinfarction ventricular tachycardia.

Abstract

BACKGROUND Successful late potential (LP) abolition and postprocedural ventricular tachycardia (VT) noninducibility constitute significant end points after catheter ablation for VT. We investigated the prognostic impact of a combined procedural end point of VT noninducibility and LP abolition in a large series of post-myocardial infarction patients with VT. METHODS AND RESULTS A total of 160 (154 men, 94% with implantable cardioverter defibrillators) consecutive post-myocardial infarction patients undergoing first-time ablation procedures from 2010 to 2012 were included. Of the 159 patients surviving the procedure, 137 (86%) were either inducible or in VT at baseline and 103 (65%) had baseline LP presence, of which 79 (77%) underwent successful LP abolition. The combined end point was assessable in 155 (97%) patients. There were 50 (32%) patients with VT recurrences and 17 (11%) cardiac deaths during follow-up. Patients who fulfilled the combined end point of VT noninducibility and LP abolition compared with inducible patients exhibited a significantly lower incidence of VT recurrence (16.4% versus 47.4%; log-rank P<0.001) and cardiac death (4.1% versus 42.1%; log-rank P<0.001). Among noninducible patients, those with additional LP abolition also had a lower incidence of VT recurrence (16.4% versus 46.0%; log-rank P<0.001). After multivariate analysis, the combined end point of VT noninducibility and LP abolition (hazard ratio, 0.205, P<0.001) was independently associated with VT recurrence and cardiac death (hazard ratio, 0.106; P=0.001). CONCLUSIONS Achieving a combined catheter ablation procedural end point of VT noninducibility and LP abolition reduces VT recurrence rates to low levels (16%). The overall strategy was associated with a significant impact on cardiac survival.

DOI: 10.1161/CIRCEP.113.001239
0102030201520162017
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@article{Silberbauer2014NoninducibilityAL, title={Noninducibility and late potential abolition: a novel combined prognostic procedural end point for catheter ablation of postinfarction ventricular tachycardia.}, author={John Silberbauer and Teresa Oloriz and Giuseppe Maccabelli and Dimitris L Tsiachris and Francesca Baratto and Pasquale Vergara and Hiroya Mizuno and Caterina Bisceglia and Alessandra Marzi and Nicoleta Carmen Sora and Fabrizio Guarracini and Andrea Radinovic and Manuela Cireddu and Simone Sala and Simone Gulletta and Gabriele Paglino and Patrizio Mazzone and Nicola Trevisi and Paolo della Bella}, journal={Circulation. Arrhythmia and electrophysiology}, year={2014}, volume={7 3}, pages={424-35} }