Catheter ablation of scar based ventricular tachycardia - Procedural characteristics and outcomes

Indian Heart J. Nov-Dec 2020;72(6):563-569. doi: 10.1016/j.ihj.2020.09.009. Epub 2020 Sep 19.

Abstract

Background: Ventricular tachycardia (VT) is a major cause of morbidity in patients with cardiomyopathy. Radiofrequency ablation has emerged as the mainstay of the management of recurrent sustained VT in these patients. We describe the clinical characteristics, procedural and medium term outcomes of patients undergoing ablation of scar VT in a tertiary care center in India.

Methods: This was a single-center descriptive cohort study. All patients who underwent ablation for scar related VT were included. Endpoints were immediate procedural success, procedural complications and recurrence during follow up.

Results: A total of 72 patients with scar VT underwent ablation with electroanatomic mapping. Previous myocardial infarction (MI) was the commonest etiology (69.4%) with arrhythmogenic right ventricular cardiomyopathy (ARVC) being the next common (19.4%). Acute procedural success was achieved in 69.4% patients, partial success in 9.7% and failure in 1 patient (1.4%). Outcome was labeled indeterminate in 19.4% who did not undergo post ablation VT induction. Procedural complications were seen in 4%. Follow up data was available in 95% of the patients with a mean follow up of 28.9 ± 22.8 months. At one year, freedom from VT was 83.8% and mortality was 13.2%. Overall mortality during follow up was 22.1% while VT recurrence was seen in 35.3%. Recurrence rate was higher in ARVC as compared to previous MI.

Conclusions: Ablation of scar VT has high acute success rates. Ablation is safe with low risk of major complications. Rates of recurrence are higher in patients with ARVC as compared to post MI VT.

Keywords: Ablation; Arrhythmia; Cardiomyopathy; Electroanatomic mapping; Ventricular tachycardia.

MeSH terms

  • Catheter Ablation / methods*
  • Female
  • Follow-Up Studies
  • Heart Conduction System / physiopathology*
  • Humans
  • Male
  • Middle Aged
  • Recurrence
  • Retrospective Studies
  • Tachycardia, Ventricular / physiopathology
  • Tachycardia, Ventricular / surgery*
  • Treatment Outcome