Noninducibility of VT after VT ablation is associated with improved arrhythmia-free survival and all-cause mortality
BACKGROUND Although ventricular tachycardia ( VT ) ablation is a widely used therapy for patients with VT , the ideal end points for this procedure are not well defined .
We performed a meta- analysis of the published literature to assess the predictive value of noninducibility of postinfa rct ion VT for long-term outcomes after VT ablation .
Treatment of ventricular tachycardia by transcatheter radiofrequency ablation in patients with ischemic heart disease.
BACKGROUND Recurrent sustained ventricular tachycardia ( VT ) is not responsive to antiarrhythmic drugs in the majority of patients , who therefore need therapy with nonpharmacological methods . We evaluated prospect ively the feasibility , safety , and efficacy of transcatheter radiofrequency ( RF ) ablation of VT in 21 selected patients with ischemic heart disease and VT . METHODS AND RESULTS Twenty-one patients with ischemic heart disease and recurrent , drug-refractory VT documented by 12-lead ECG were selected who had sufficient hemodynamic tolerance of VT to undergo transcatheter mapping . Documented clinical VT was reproduced by programmed cardiac stimulation ( PCS ) , and the site of origin was localized by a combination of techniques , including pace mapping , activation-sequence mapping , recordings of middiastolic potentials , and application of re setting and entrainment principles . RF current at 55 V was applied ( 3.8 + /- 3.1 applications per patient ) for as long as 30 seconds at a time to target sites . Twenty-four distinct clinical VTs ( mean cycle length , 445 + /- 52 milliseconds ) were mapped and ablated in 21 patients . In 17 of 21 patients ( 81 % ) , the procedure was acutely successful , and the target clinical VT could no longer be induced by PCS after the procedure , whereas in 4 patients , clinical VT remained inducible . By contrast , VTs with shorter cycle length and different QRS morphology than the ablated VT could still be induced by PCS in 12 of 21 patients . One patient died in intractable congestive heart failure 10 days after the procedure , and the remaining 20 are alive at the end of the follow-up period . The majority of the patients continued to be treated with at least one additional mode of antiarrhythmic therapy ; 12 patients were still taking antiarrhythmic drugs , and 9 patients received an implantable cardioverter/defibrillator . During a mean follow-up period of 13.2 + /- 5.0 months , 9 of 20 patients ( 45 % ) had recurrent VT . In 4 patients , the recurrent VT was different than the previously ablated one . Clinical VT recurred in all 4 patients in whom RF ablation had been acutely unsuccessful . Four patients with recurrent VT underwent repeat RF ablation procedures that were acutely successful and had no further recurrence . CONCLUSION Transcatheter RF ablation is feasible but has only moderately high efficacy in a small , selected group of patients with ischemic heart disease and drug-refractory , highly frequent , hemodynamically tolerated , sustained VT . In the majority of the patients , this treatment technique is palliative rather than definitive , and many of the patients continue to require other methods of antiarrhythmic therapy
Noninducibility of VT after VT ablation is associated with improved arrhythmia-free survival and all-cause mortality
BACKGROUND Although ventricular tachycardia ( VT ) ablation is a widely used therapy for patients with VT , the ideal end points for this procedure are not well defined .
We performed a meta- analysis of the published literature to assess the predictive value of noninducibility of postinfa rct ion VT for long-term outcomes after VT ablation .