Non-Inducibility and Late Potential Abolition: A Novel Combined Prognostic Procedural Endpoint for Catheter Ablation of Post-infarction Ventricular Tachycardia
Background—Successful late potential (LP) abolition and post-procedural ventricular tachycardia (VT) non-inducibility constitute significant endpoints after catheter ablation for VT. We investigated the prognostic impact of a combined procedural endpoint of VT non-inducibility and LP abolition in a large series of post-myocardial infarction (MI) patients with VT.
Methods and Results—160 (154 male, 94% with ICDs) consecutive post-MI patients undergoing first-time ablation procedures from 2010-2012 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 endpoint was assessable in 155 (97%) patients. There were 50 (32%) patients with VT recurrences and 17 (11%) cardiac deaths during follow-up. Patients that fulfilled the combined end-point of VT non-inducibility and LP abolition compared to inducible patients exhibited a significantly lower incidence of VT recurrence (16.4% vs. 47.4%, log-rank p<0.001) and cardiac death (4.1% vs. 42.1%, log-rank p<0.001). Among non-inducible patients, those with additional LP abolition also had a lower incidence of VT recurrence (16.4% vs. 46.0%, log-rank p<0.001). After multivariate analysis, the combined endpoint of VT non-inducibility and LP abolition (HR 0.205, p<0.001) was independently associated with VT recurrence and cardiac death (HR 0.106, p=0.001).
Conclusions—Achieving a combined catheter ablation procedural endpoint of VT non-inducibility and LP abolition reduces VT recurrence rates to very low levels (16%). The overall strategy was associated with a significant impact on cardiac survival.
- Received September 2, 2013.
- Revision received April 7, 2014.
- Accepted April 9, 2014.