Substrate-based catheter ablation, used when activation/entrainment mapping was unfeasible, resulted in comparable sustained VT recurrences over 5 years (30.0% vs 42.9%, P=0.22).
Cohort (n=85)
Does a substrate-based mapping strategy reduce sustained VT recurrences and cardiac death compared to an activation/entrainment-based strategy in patients with structural heart disease undergoing catheter ablation for ventricular tachycardia?
Substrate-based mapping is a viable alternative to activation/entrainment mapping for ventricular tachycardia ablation in structural heart disease, yielding comparable long-term outcomes.
Tasa de eventos absoluta: 30% vs 42.9%
valor p: p=0.22
Background Substrate‐based catheter ablation (CA) can be applied to more complicated cases such as hemodynamically unstable ventricular tachycardia (VT). We aimed to compare the efficacy between substrate‐based and activation/entrainment‐based ablation. Methods We investigated 85 consecutive patients (62 male, 53 ± 16 years) who underwent CA of VT to analyze the relationship between the ablation strategy and clinical outcome. The patients included 34 individuals with arrhythmogenic right ventricular cardiomyopathy, 16 with ischemic heart disease, 14 with dilated cardiomyopathy, 11 with sarcoidosis, and 10 with other heart diseases. The primary strategy was activation/entrainment mapping (Group‐AE, N = 35); otherwise, substrate‐based strategy was adopted (Group‐S, N = 50) because of non‐inducibility of VT or hemodynamic instability. Successful CA was defined as the non‐inducibility of any VT at the end of the procedure in those with inducible clinical VT before ablation, and substrate elimination in those without. Results There were no significant differences in the left ventricular function, percentage of implantable cardioverter‐defibrillator implantations, results of CA, and number of radiofrequency applications between Group‐S and Group‐AE. During 5 years of follow‐up, there were no significant differences in sustained VT recurrences (15/50 vs. 15/35, P = 0.22), and cardiac death (2/50 vs. 3/35, P = 0.38). In patients with inducible VT before ablation, the elimination of the VT inducibility was associated with a lower recurrence rate (12/47 vs. 16/26, P = 0.003). Conclusions The substrate‐based strategy adopted as an alternative option when the activation/entrainment‐based strategy was unable to be performed resulted in a comparable VT recurrence rate. The extinction of VT inducibility achieved a favorable prognosis in structural heart disease patients.
Makimoto et al. (Sat,) conducted a cohort in Ventricular tachycardia in patients with structural heart disease (n=85). Substrate-based catheter ablation vs. Activation/entrainment-based ablation was evaluated on Sustained VT recurrences (p=0.22). Substrate-based catheter ablation, used when activation/entrainment mapping was unfeasible, resulted in comparable sustained VT recurrences over 5 years (30.0% vs 42.9%, P=0.22).
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