Ventricular tachycardia ablation in structural heart disease: Impact of ablation strategy and non-inducibility as an end-point on long term outcome

Int J Cardiol. 2019 Feb 15;277:110-117. doi: 10.1016/j.ijcard.2018.08.099. Epub 2018 Sep 1.

Abstract

Background: To investigate the long term outcomes after catheter ablation (CA) of ventricular tachycardia (VT) in the context of structural heart disease in a multicenter cohort. The impact of different ablation strategies (substrate ablation versus activation guided versus combined) and non-inducibility as an end-point was evaluated.

Methods: Data was pooled from prospective registries at 5 centres over a 5 year period. Success was defined as survival free from recurrent ventricular arrhythmias (VA). Multivariate analysis of factors predicting survival free from VA was analysed by Cox regression.

Results: Five hundred sixty-six patients underwent CA for VT. Patients were 64 ± 15 years. Left ventricular ejection fraction was 35 ± 15% and 66% had ischaemic heart disease. At 2.3 (IQR 1.0-4.2) years, success was achieved in 44% after a single procedure, rising to 60% after repeat procedures. Mortality at final follow up was 22%. Multivariate analysis showed that higher left ventricular ejection fraction, younger age, ischaemic heart disease, and non-inducibility of VA predicted long term survival free from VA (all p < 0.05). There was no impact of the approach to ablation.

Conclusion: CA eliminates VT in a large proportion of patients long term. Ablation strategy did not impact outcome and hence substrate ablation is a reasonable initial strategy. Non-inducibility of VA predicted survival free from VA and may be worth pursuing as a procedural end-point.

Keywords: Catheter ablation; Outcome; Ventricular tachycardia.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Catheter Ablation / mortality
  • Catheter Ablation / trends*
  • Cohort Studies
  • Endpoint Determination / mortality
  • Endpoint Determination / trends*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Mortality / trends
  • Prospective Studies
  • Registries
  • Tachycardia, Ventricular / diagnosis*
  • Tachycardia, Ventricular / mortality
  • Tachycardia, Ventricular / surgery*
  • Treatment Outcome