Predictive Value of Programmed Ventricular Stimulation After Catheter Ablation of Post-Infarction Ventricular Tachycardia

Yokokawa, Miki; Kim, Hyungjin Myra; Baser, Kazim; Stevenson, William G.; Nagashima, Koichi; Bella, Paolo Della; Vergara, Pasquale; Hindricks, Gerhard; Arya, Arash; Zeppenfeld, Katja; Silva, Marta de Riva; Daoud, Emile G.; Kumar, Sunil; Kuck, Karl Heinz; Tilz, Ronald; Mathew, Shibu; Ghanbari, Hamid; Latchamsetty, Rakesh; Morady, Fred; Bogun, Frank

doi:10.1016/j.jacc.2015.02.058

Cited by 88 publications

(48 citation statements)

References 8 publications

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“…In particular, unipolar voltage mapping may have even greater sensitivity for identifying subtle areas of abnormality. For example, larger areas of unipolar voltage abnormality were recently shown to predict irreversibility of NICM in patients without scar detected by MRI or bipolar voltage mapping(16).In contrast to a recent multicenter report(17), acute procedural success was not significantly associated with the primary endpoint in our multivariate model (p ¼ 0.06). It is likely that with a larger sample size, the association would have been statistically significant.Through the incorporation of electrophysiological risk factors, we aimed to improve risk stratification of patients with NICM beyond LVEF.…”

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confidence: 81%

Electrophysiological Predictors of Transplantation and Left Ventricular Assist Device-Free Survival in Patients With Nonischemic Cardiomyopathy Undergoing Ventricular Tachycardia Ablation

Frankel

Liang

Supple

et al. 2015

JACC: Clinical Electrophysiology

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contrasting

confidence: 81%

Electrophysiological Predictors of Transplantation and Left Ventricular Assist Device-Free Survival in Patients With Nonischemic Cardiomyopathy Undergoing Ventricular Tachycardia Ablation

Frankel

Liang

Supple

et al. 2015

JACC: Clinical Electrophysiology

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“…The population in the current study is an extension of a previously published cohort, 6 with the inclusion of one additional VT ablation center and with additional patients and longer follow-up from all centers. All consecutive patients undergoing catheter ablation for infarct-related VT were eligible for inclusion.…”

Section: Methodsmentioning

confidence: 99%

“…6 Briefly, after informed consent was obtained, programmed stimulation was performed with ≤4 extra stimuli from multiple right ventricular locations with coupling intervals down to 200 ms or refractoriness, whichever occurred first, in an attempt to induce VT unless the patient was in VT at the beginning of the procedure. Clinical VT was defined on the basis of 12-lead electrocardiograms or VT electrogram morphology from ICD recordings.…”

Section: Methodsmentioning

confidence: 99%

Prognostic Impact of the Timing of Recurrence of Infarct-Related Ventricular Tachycardia After Catheter Ablation

Siontis

Kim

Stevenson

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background Recurrence of ventricular tachycardia (VT) after ablation in patients with previous myocardial infarction is associated with adverse prognosis. However, the impact of the timing of VT recurrence on outcomes is unclear. Methods and Results We analyzed data from a multicenter collaborative database of patients who underwent catheter ablation for infarct-related VT. Multivariable Cox regression analyses investigated the effect of the timing of VT recurrence on the composite outcome of death or heart transplantation using VT recurrence as a time-varying covariate. A total of 1412 patients were included (92% men; age: 66.7±10.7 years), and 605 patients (42.8%) had a recurrence after median 116 days (188 [31.1%] within 1 month, 239 [39.5%] between 1 and 12 months, and 178 [29.4%] after 12 months). At median follow-up of 670 days, 375 patients (26.6%) experienced death or heart transplantation. The median time from recurrence to death or heart transplantation was 65 and 198.5 days in patients with recurrence ≤30 days and >30 days post ablation, respectively. The adjusted hazard ratio (95% confidence interval) for the effect of VT recurrence occurring immediately post ablation on death or heart transplantation was 3.45 (2.33–5.11) in reference to no recurrence. However, the magnitude of this effect decreased statistically significantly (P<0.001) as recurrence occurred later in the follow-up period. The respective risk estimates for VT recurrence at 30 days, 6 months, 1 year, and 2 years were 3.36 (2.29–4.93), 2.94 (2.09–4.14), 2.50 (1.85–3.37), and 1.81 (1.37–2.40). Conclusions VT recurrence post ablation is associated with a mortality risk that is highest soon after the ablation and decreases gradually thereafter.

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“…Ablation techniques aiming at the elimination of the endocardial LPs and scar homogenization have been proven effective in treating VT. [3][4][5][6] Although the VT noninducibility after catheter ablation (CA) is commonly used as a procedural end point, some important limitations question the role of programmed ventricular stimulation (PVS) as a proof of long-term success after ablation. [7][8][9] We suggested that the LPs in SAECG correlate with the endocardial scar area and LPs in electro-anatomic maps of patients with ischemic cardiomyopathy. Further, we hypothesized that substrate-guided ablation and abolition of the endocardial LPs can result in normalization of the SAECG.…”

mentioning

confidence: 91%

Signal-Averaged Electrocardiography as a Noninvasive Tool for Evaluating the Outcomes After Radiofrequency Catheter Ablation of Ventricular Tachycardia in Patients With Ischemic Heart Disease

Dinov

Bode

Koenig

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background— Inducibility of ventricular tachycardia (VT) has limited ability to predict recurrent VT after catheter ablation (CA). We sought to correlate the signal-averaged ECG (SAECG) with the endocardial scar characteristics in patients with ischemic VTs. We suggest that successful CA can result in normalization of the SAECG. Methods and Results— Fifty patients (42 male; aged 67±10 years, ejection fraction 34±12%) with ischemic VTs were prospectively enrolled. SAECG was performed before and after CA. Patients with at least 2 abnormal criteria (filtered QRS ≥114 ms; root mean square 40 <20 μV, and low-amplitude potentials 40 >38 ms) were defined as having positive SAECG. There was a linear correlation between endocardial scar area (<1.5 mV) and filtered QRS ( r =0.414; P =0.003). CA resulted in normalization of the SAECG in 6 patients. In patients with filtered QRS ≤120 ms, 13 (40.6%) patients had normal SAECG after CA compared with 7 (21.9%) before ablation ( P =0.034). Patients with normal or normalized SAECG after CA had better VT-free survival compared with those whose SAECG remained abnormal. Abnormal SAECG after CA was a predictor for VT recurrence: hazard ratio=3.64; P =0.039 for the overall population, and hazard ratio=5.80; P =0.022 for patients having QRS ≤120 ms. Conclusions— There is a significant correlation between the surface SAECG and endocardial scar size in patients with ischemic VTs. A successful CA can result in normalization of SAECG that is associated with more favorable long-term outcomes. SAECG can be useful to assess the procedural success of VT ablation.

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Predictive Value of Programmed Ventricular Stimulation After Catheter Ablation of Post-Infarction Ventricular Tachycardia

Abstract: Noninducibility after VT ablation in patients with post-infarction VT is independently associated with lower mortality during long-term follow-up.

Cited by 88 publications

References 8 publications

Electrophysiological Predictors of Transplantation and Left Ventricular Assist Device-Free Survival in Patients With Nonischemic Cardiomyopathy Undergoing Ventricular Tachycardia Ablation

Electrophysiological Predictors of Transplantation and Left Ventricular Assist Device-Free Survival in Patients With Nonischemic Cardiomyopathy Undergoing Ventricular Tachycardia Ablation

Prognostic Impact of the Timing of Recurrence of Infarct-Related Ventricular Tachycardia After Catheter Ablation

Signal-Averaged Electrocardiography as a Noninvasive Tool for Evaluating the Outcomes After Radiofrequency Catheter Ablation of Ventricular Tachycardia in Patients With Ischemic Heart Disease

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