Meta-analysis of catheter ablation as an adjunct to medical therapy for treatment of ventricular tachycardia in patients with structural heart disease

Mallidi, Jaya; Nadkarni, Girish N.; Berger, Ronald D.; Calkins, Hugh; Nazarian, Saman

doi:10.1016/j.hrthm.2010.12.015

Cited by 104 publications

(55 citation statements)

References 27 publications

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“…In other series, VT ablation has failed to demonstrate a survival improvement. 20,21 In our study, a reduction in terms of hospital admission because of a VT or need of reablation or even a trend toward less VT recurrences in the Epi-Group did not associate with a mortality reduction. The only predictor of mortality was previous cardiac surgery.…”

Section: Discussioncontrasting

confidence: 46%

Endo-Epicardial Versus Only-Endocardial Ablation as a First Line Strategy for the Treatment of Ventricular Tachycardia in Patients With Ischemic Heart Disease

Izquierdo

Sánchez-Gómez

Loma-Osorio

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Background-Epicardial ablation has shown improvement in clinical outcomes of patients with ischemic heart disease (IHD) after ventricular tachycardia (VT) ablation. However, usually epicardial access is only performed when endocardial ablation has failed. Our aim was to compare the efficacy of endocardial+epicardial ablation versus only endocardial ablation in the first procedure in patients with IHD. Methods and Results-Fifty-three patients with IHD, referred for a first VT ablation to our institution, from 2012 to 2014, were included. They were divided in 2 groups according to enrollment time: from May 2013, we started to systematically perform endo-epicardial access (Epi-Group) as first-line approach in consecutive patients with IHD (n=15). Patients who underwent only an endocardial VT ablation in their first procedure (Endo-Group) included patients with previous cardiac surgery and the historical (before May 2013; n=35). All late-potentials in the scar zone were eliminated, and if VT was tolerated, critical isthmuses were also approached. The end point was the noninducibility of any VT. During a median follow-up of 15±10 months, the combined end point (hospital or emergency admission because of a ventricular tachycardia or reablation) occurred in 14 patients of the Endo-group and in one patient in the Epi-group (event-free survival curves by P=0.03). Ventricular arrhythmia recurrences occurred in 16 and in 3 patients in the Endo and Epi-Group, respectively (Grey-test, P=0.2). Conclusions-A combined endocardial-epicardial ablation approach for initial VT ablation was associated with fewer readmissions for VT and repeat ablations. Izquierdo et al Epicardial Ablation of Ischemic VT 883contraindications to epicardial ablation, because of physician preference (usually related to the lack of experience in epicardial access during the learning curve of the technique). -This study was approved by the Institutional Review Board and all patients signed an informed written consent. VT AblationThe procedure was performed under local anesthesia and conscious sedation. A quadripolar diagnostic catheter was introduced via the right femoral vein to the right ventricular apex. The left ventricle was accessed retrogradely through the aortic valve, via a transseptal puncture, or both. Electroanatomical left ventricle maps were obtained using CARTO 3 (Biosense Webster, Diamond Bar, CA) or EnSite NavX (St Jude Medical, St Paul, MN). For ablation 3.5 to 4 mm saline-irrigated tip ablation catheters (Navistar Thermocool, Celsius Thermocool [Biosense Webster] or CoolFlex [ST Jude]) were used. Simultaneous recordings of ventricular bipolar electrograms (bandpass filtered 30-500 Hz) and 12-lead surface ECG were stored digitally (Prucka Cardiolab; GE Medical Systems, Milwaukee, WI). The procedures were performed under intravenous anticoagulation with sodium heparin (initial bolus of 50-100 IU/kg followed by a 1000 IU/h perfusion adjusted to maintain the partial time of tromboplastine activated above 250 s). If the VT was not incessa...

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Section: Discussioncontrasting

confidence: 46%

Endo-Epicardial Versus Only-Endocardial Ablation as a First Line Strategy for the Treatment of Ventricular Tachycardia in Patients With Ischemic Heart Disease

Izquierdo

Sánchez-Gómez

Loma-Osorio

et al. 2015

Circ: Arrhythmia and Electrophysiology

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“…Acute suppression of VTs by radiofrequency energy application has been reported in 75% to 95% of patients, with a recurrence rate of up to 35% [37,38] . Although the recurrence rate seems high, it is much lower than in patients receiving only antiarrhythmic drugs, according to a recent meta-analysis [39] . This meta-analysis considered 154 potential studies on catheter ablation of VT associated with structural heart disease and included only 5.…”

Section: Resultsmentioning

confidence: 99%

Role of catheter ablation of ventricular tachycardia associated with structural heart disease

Ponti

2011

WJC

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In patients with structural heart disease, ventricular tachycardia (VT) worsens the clinical condition and may severely affect the short-and long-term prognosis. Several therapeutic options can be considered for the management of this arrhythmia. Among others, catheter ablation, a closed-chest therapy, can prevent arrhythmia recurrences by abolishing the arrhythmogenic substrate. Over the last two decades, different techniques have been developed for an effective approach to both tolerated and untolerated VTs. The clinical outcome of patients undergoing ablation has been evaluated in multiple studies. This editorial gives an overview of the role, methodology, clinical outcome and innovative approaches in catheter ablation of VT. De Ponti R. Role of catheter ablation of ventricular tachycardia associated with structural heart disease.

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“…In this study, VT recurrence was 37.3% if ablation was performed within 30 days of the first arrhythmic event, versus 61.9% in patients who had ablation 430 days to 1 year after the first event. While the SMASH VT and VTACH trial were not powered to evaluate mortality benefit from catheter ablation, a 2011 meta-analysis 24 of four studies demonstrated a 35% reduction in VT and a non-significant trend towards reduced mortality with ablation with a relative risk of 0.76 (0.41-1.38; p ¼ 0.37). The largest multicenter retrospective study to date by the International VT Ablation Center Collaborative Group reported a 70% freedom from VT at 1 year in patients with ischemic cardiomyopathy and non-ischemic etiologies.…”

Section: Current Statementioning

confidence: 99%

Catheter Ablation at the Forefront: The Tribulations of Clinical Trials

Bradfield¹,

Tung²

2016

JICRM

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ABSTRACT. Radiofrequency ablation (RFA) has become an essential component of ventricular tachycardia (VT) management. In the era of implantable cardioverter-defibrillators (ICDs), antiarrhythmic therapy and RFA are frequently required for patients with both primary prevention and secondary prevention indications for ICD implant. ''VT ablation'' encompasses ablation across a spectrum of various ventricular arrhythmias. In addition to ablation of monomorphic VT in the setting of structural heart disease, the evolving field also includes VT in structurally normal hearts (idiopathic VT), premature ventricular contractions (PVC) ablation (for symptoms and optimization of cardiomyopathy), and ablation of ventricular fibrillation via targeting of triggering PVCs. While these sub-categories of VT ablation represent significant advancement in the breadth of the field, the focus of this article is to review the evidence for catheter ablation of monomorphic VT in the setting of structural heart disease and to discuss future studies that are anticipated.

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Meta-analysis of catheter ablation as an adjunct to medical therapy for treatment of ventricular tachycardia in patients with structural heart disease

Abstract: Background-Most studies of catheter ablation for treatment of ventricular tachycardia (VT) are relatively small observational trials.

Cited by 104 publications

References 27 publications

Endo-Epicardial Versus Only-Endocardial Ablation as a First Line Strategy for the Treatment of Ventricular Tachycardia in Patients With Ischemic Heart Disease

Endo-Epicardial Versus Only-Endocardial Ablation as a First Line Strategy for the Treatment of Ventricular Tachycardia in Patients With Ischemic Heart Disease

Role of catheter ablation of ventricular tachycardia associated with structural heart disease

Catheter Ablation at the Forefront: The Tribulations of Clinical Trials

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