Impact of New Technologies and Approaches for Post–Myocardial Infarction Ventricular Tachycardia Ablation During Long-Term Follow-Up
Résumé
Background: Over the past years, many innovations have been introduced to facilitate catheter ablation of post-myocardial infarction ventricular tachycardia (post-MI VT). However, the predictors of outcome after ablation were not thoroughly studied.
Methods and results: From 2009 to 2013, consecutive patients referred for post-MI VT ablation were included. The endpoint of the procedure was complete elimination of local abnormal ventricular activities (LAVA) and VT non-inducibility. The predictors of outcome with primary endpoint of VT recurrence were assessed. A total of 125 patients were included (64±11y, 7 women) for 142 procedures. The left ventricle was accessed via transseptal, retrograde-aortic and epicardial approach in 87%, 33% and 37%, respectively. 3-dimensional electroanatomical mapping system (3D-EAM) was used in 70%, multipolar catheter in 51% and real-time image integration in 38% (from MRI in 39%, MDCT in 93%). Before ablation VT was inducible in 75%, and endocardial/epicardial LAVA were present in 88%/75%. After ablation, complete LAVA elimination was achieved in 60%, and VT non-inducibility in 83%. Over a median follow-up of 850 days (IQR 439-1707), VT recurrence was observed in 36%. Multivariable analysis identified 3 independent outcome predictors: the ability to achieve complete LAVA elimination (R2=0.29, P<0.0001, risk ratio=0.52 [0.38-0.70]), the use of real-time image integration (R2=0.21, P=0.0006, risk ratio=0.49 [0.33-0.74]) and the use of multipolar catheters (R2=0.08, P=0.05, risk ratio=0.75[0.56-1.00]).
Conclusion: Achievement of complete LAVA elimination, use of scar integration from maging and multipolar catheters to focus high-density mapping are independent predictors of VT free survival after catheter ablation for post-MI VT.
| Origine | Accord explicite pour ce dépôt |
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