Long-term outcome of ventricular tachycardia ablation in patients who did not undergo programmed electrical stimulation after ablation

• Published in: Journal of interventional cardiac electrophysiology Vol. 66; no. 1; pp. 215 - 220
• Main Authors: Kitamura, Takeshi, Fukamizu, Seiji, Arai, Tomoyuki, Kawajiri, Kohei, Tanabe, Sho, Tokioka, Sayuri, Inagaki, Dai, Hojo, Rintaro
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-01-2023; Springer Nature B.V
• Subjects: Ablation; Arrhythmia; Cardiac arrhythmia; Cardiology; Cardiovascular diseases; Catheter Ablation - methods; Complications; Electric Stimulation - adverse effects; Electrical stimuli; Heart diseases; Hemodynamics; Humans; Medical instruments; Medicine; Medicine & Public Health; Stimulation; Substrates; Tachycardia; Tachycardia, Ventricular; Treatment Outcome; Ventricle; VT ablation; Programmed ventricular stimulation; Catheter ablation
• ISSN: 1572-8595; 1383-875X; 1572-8595
• DOI: 10.1007/s10840-021-01037-4

Background
Ventricular arrhythmia inducibility is one of the ideal endpoints of ventricular tachycardia (VT) ablation. However, it may be challenging to implement programmed electrical stimulation (PES) at the end of the procedure under several circumstances. The long-term outcome of patients who did not undergo PES after VT ablation remains largely unknown.
Purpose
To investigate the details and long-term outcome of VT ablation in patients who did not undergo PES at the end of the ablation procedure.
Methods
Among 183 VT ablation procedures in patients with structural heart disease who underwent VT ablation using an irrigated catheter, we enrolled those who did not undergo PES after VT ablation. VT ablation strategy involved targeting clinical VT plus pacemap-guided substrate ablation if inducible. When VT was not inducible, substrate-based ablation was performed. The primary endpoint was VT recurrence.
Results
In 58 procedures, post-ablation VT inducibility was not assessed. The causes were non-inducibility of sustained VT before ablation (27/58, 46.6%), long procedure time (27.6%, mean 392 min), complications (10.3%), intolerant hemodynamic state (10.3%), and inaccessible or unsafe target (6.9%). With regard to the primary endpoint, 23 recurrences (39.7%) were observed during a mean follow-up period of 2.5 years. Patients with non-inducibility before ablation showed less VT recurrences (4/27, 14.8%) during follow-up than patients with other causes of untested PES after ablation (19/31, 61.2%) (Log-rank < 0.001).
Conclusions
VT recurrence was not observed in approximately 60% of the patients who did not undergo PES at the end of the ablation procedure. PES after VT ablation may be not needed among patients with pre-ablation non-inducibility.