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Circ Arrhythm Electrophysiol. 2018 Feb;11(2):e005635. doi: 10.1161/CIRCEP.117.005635.

Long-Term Outcome of Substrate Modification in Ablation of Post-Myocardial Infarction Ventricular Tachycardia.

Author information

1
From the Service de Cardiologie-Électrophysiologie et Stimulation Cardiaque, Université de Bordeaux, IHU LIRYC, CHU de Bordeaux, France. michael.wolf@telenet.be.
2
From the Service de Cardiologie-Électrophysiologie et Stimulation Cardiaque, Université de Bordeaux, IHU LIRYC, CHU de Bordeaux, France.

Abstract

BACKGROUND:

Long-term results of substrate modification for ablation of ventricular tachycardia (VT) have not been reported. We report long-term outcomes of substrate elimination targeting local abnormal ventricular activities (LAVA) for post-myocardial infarction VT.

METHODS AND RESULTS:

One hundred fifty-nine consecutive patients undergoing first ablation were included (65±11 years, 92% implantable cardioverter defibrillators, 54% storms, and 73% appropriate shocks). LAVA were identified in 92% and VT was inducible in 73%. Complete LAVA elimination and noninducibility after ablation were achieved in 64% and 85%. During a median follow-up of 47 months (interquartile range, 34-82), single-procedure ventricular arrhythmia (VA)-free survival was 55% (10% storms and 19% shocks). The VA-free survival was 73%, 68%, 61%, 55%, and 49% after 1, 2, 3, 4, and 5 years, respectively. Complete LAVA elimination was associated with improved outcomes: VA-free survival of 82% at 1 year and 61% at 5 years. In the subgroup treated with multielectrode mapping and real-time image integration, VA-free survival was 86% and 65% at 1 year and 4 years, respectively. Including repeat procedures in 18% of pts (1.3±0.6 ablations/pt) outcomes improved to 69% VA-free survival (2% storms and 9% shocks) during median 46-month follow-up. Overall survival was 91% at 1 year and 77% at 5 years of follow-up.

CONCLUSIONS:

In this monocentric study, substrate modification targeting LAVA for post-myocardial infarction VT resulted in a substantial reduction of VT storm and implantable cardioverter defibrillator shocks and up to 49% of patients free from arrhythmia at 5 years after a single procedure. Complete LAVA elimination, multielectrode mapping, and real-time integration were associated with improved VA-free survival.

KEYWORDS:

LAVA; catheter ablation; image-integration; multielectrode mapping; substrate modification; ventricular tachycardia

PMID:
29440186
DOI:
10.1161/CIRCEP.117.005635

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