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 .
Catheter ablation of stable ventricular tachycardia before defibrillator implantation in patients with coronary heart disease (VTACH): a multicentre randomised controlled trial
BACKGROUND In patients with ventricular tachycardia ( VT ) and a history of myocardial infa rct ion , intervention with an implantable cardioverter defibrillator ( ICD ) can prevent sudden cardiac death and thereby reduce total mortality . However , ICD shocks are painful and do not provide complete protection against sudden cardiac death . We assessed the potential benefit of catheter ablation before implantation of a cardioverter defibrillator . METHODS The Ventricular Tachycardia Ablation in Coronary Heart Disease ( VTACH ) study was a prospect i ve , open , r and omised controlled trial , undertaken in 16 centres in four European countries . Patients aged 18 - 80 years were eligible for enrolment if they had stable VT , previous myocardial infa rct ion , and reduced left-ventricular ejection fraction ( LVEF ; < or=50 % ) . 110 patients were r and omly allocated in a 1:1 ratio to receive catheter ablation and an ICD ( ablation group , n=54 ) or ICD alone ( control group , n=56 ) . R and omisation was done by computer-generated r and omly permuted blocks and stratified by centre and LVEF ( < or=30 % or > 30 % ) . Patients were followed up for at least 1 year . The primary endpoint was the time to first recurrence of VT or ventricular fibrillation ( VF ) . Analysis was by intention to treat ( ITT ) . This study is registered with Clinical Trials.gov , number NCT00919373 . FINDINGS 107 patients were included in the ITT population ( ablation group , n=52 ; control group , n=55 ) . Two patients ( one in each group ) withdrew consent immediately after r and omisation without any follow-up data and one patient ( ablation group ) was excluded because of a protocol violaton . Mean follow-up was 22.5 months ( SD 9.0 ) . Time to recurrence of VT or VF was longer in the ablation group ( median 18.6 months [ lower quartile 2.4 , upper quartile not determinable ] ) than in the control group ( 5.9 months [ IQR 0.8 - 26.7 ] ) . At 2 years , estimates for survival free from VT or VF were 47 % in the ablation group and 29 % in the control group ( hazard ratio 0.61 ; 95 % CI 0.37 - 0.99 ; p=0.045 ) . Complications related to the ablation procedure occurred in two patients ; no deaths occurred within 30 days after ablation . 15 device-related complications requiring surgical intervention occurred in 13 patients ( ablation group , four ; control group , nine ) . Nine patients died during the study ( ablation group , five ; control group , four ) . INTERPRETATION Prophylactic VT ablation before defibrillator implantation seemed to prolong time to recurrence of VT in patients with stable VT , previous myocardial infa rct ion , and reduced LVEF .  Prophylactic catheter ablation should therefore be considered before implantation of a cardioverter defibrillator in such patients . FUNDING St Jude Medical
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 .