Key result
Evoked delayed potential ablation yields ~72% 1-year VT-free survival, regardless of center experience.
Why the study?
Does evoked delayed potential ablation prevent ventricular tachycardia recurrence in patients with post-myocardial infarction ventricular tachycardia?
Cohort (n=130)
Yes
Does evoked delayed potential ablation prevent ventricular tachycardia recurrence in patients with post-myocardial infarction ventricular tachycardia?
Hazard Ratio: 0.687 (95% CI 0.322–1.462)
Absolute Event Rate: 23% vs 30%
p-value: p=0.330
Evoked delayed potential ablation is an effective and reproducible strategy for preventing VT recurrence in post-MI patients, yielding good long-term outcomes regardless of prior operator experience with the technique.
Supports EDP ablation for post-MI VT regardless of experience; leaves open need for randomized confirmation before practice change.
AIMS: The optimal substrate ablation approach for post-myocardial infarction (MI) ventricular tachycardia (VT) is unknown. Proposed ablation targets are prone to individual interpretation making the ablation outcome potentially operator dependent. Evoked delayed potentials (EDPs) are a well-defined target. Evoked delayed potential ablation was effective in preventing post-MI VT recurrence in a prior study. The aims of this study were to assess long-term outcomes of EDP ablation in a large multicentre cohort of post-MI patients and to compare ablation outcomes between centres with and without prior experience in EDP ablation. METHODS AND RESULTS: Patients with post-MI VT undergoing ablation in one centre performing EDP ablation since 2013 and five centres without prior experience in EDP ablation were prospectively included. A uniform mapping protocol including right ventricular extra-stimulation aiming to EDP identification was followed. Ablation endpoints were EDP elimination and VT non-inducibility. Patients were followed for VT recurrence, mortality, heart transplant, and left ventricular assist device implantation. In total, 130 patients were included. The protocol was successfully performed in 99%, and in 94%, EDPs were identified and ablated. In total, 78% of patients were rendered non-inducible. Ventricular tachycardia-free survival was 78% [95% confidence interval (CI) 71-85] and 71% (95% CI 63-80) at 6 and 12 months, respectively. No difference in VT-free survival was observed among centres with and without prior experience in EPD ablation. CONCLUSION: In a large multicentre prospective cohort of patients with post-MI VT, EDP ablation resulted in good long-term outcomes. Importantly, VT recurrence rates did not differ among centres with and without prior experience in EDP ablation, indicating that this approach can be easily reproduced by operators previously not familiar with the technique.
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Silva et al. (2025) conducted a cohort in Post-myocardial infarction ventricular tachycardia (n=130). Evoked delayed potential (EDP) ablation in experienced centre vs. EDP ablation in centres without prior experience was evaluated on Ventricular tachycardia recurrence (HR 0.687, 95% CI 0.322-1.462, p=0.330). Evoked delayed potential ablation resulted in a 72% 1-year VT-free survival rate, with no significant difference in VT recurrence between centres with and without prior experience (HR 0.687).
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