Key result
Post-ablation VT noninducibility is linked to ~71% fewer 1-year recurrences or deaths only when LVEF >30%.
Why the study?
Does achieving noninducibility after ablation improve survival free from VT recurrence and cardiac death in patients with post-infarction ventricular tachycardia?
Cohort (n=91)
Does achieving noninducibility after ablation improve survival free from VT recurrence and cardiac death in patients with post-infarction ventricular tachycardia?
Absolute Event Rate: 90% vs 65%
p-value: p=0.015
Achieving noninducibility during VT ablation predicts better outcomes in patients with moderately depressed LV function, but not in those with severely depressed LV function (LVEF ≤30%) who have a poor prognosis regardless of acute procedural outcome.
Noninducibility may aid risk stratification in LVEF >30%; leaves open its value as ablation endpoint in severe LV dysfunction.
BACKGROUND: Noninducibility is frequently used as procedural end point of ventricular tachycardia (VT) ablation after myocardial infarction. We investigated the influence of left ventricular (LV) function on the predictive value of noninducibility for VT recurrence and cardiac mortality. METHODS AND RESULTS: Ninety-one patients (82 men, 67±10 years) with post-myocardial infarction VT underwent ablation between 2009 and 2012. Fifty-nine (65%) had an LV ejection fraction (EF) >30% (mean 41±7) and 32 (35%) an LVEF≤30% (mean 20±5). Thirty patients (51%) with EF>30% and 13 (41%) with EF≤30% were noninducible after ablation (P=0.386). During a median follow-up of 23 (Q1-Q3 16-36) months, 35 patients (38%) experienced VT recurrences and 17 (18%) cardiac death. At 1 year follow-up, survival free from VT recurrence and cardiac death for patients with LVEF>30% was 80% (95% confidence interval [CI], 70-90) compared with 42% (95% CI, 33-51) for those with LVEF≤30% (P=0.001). Noninducible patients with LVEF>30% had a recurrence-free survival from cardiac death of 90% (95% CI, 71-100) compared with 65% (95% CI, 47-83) for inducible patients (P=0.015). In the subgroup of patients with LVEF≤30%, the survival free from VT recurrence and cardiac death was 31% (95% CI, 0%-60%) for noninducible compared with 39% (95% CI, 27-52) for those who remained inducible (P=0.842). CONCLUSIONS: Noninducible patients with moderately depressed LV function have a favorable outcome compared with patients who remained inducible after ablation. On the contrary, patients with severely depressed LV function have a poor prognosis independent of the acute procedural outcome.
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Riva et al. (2015) conducted a cohort in Post-myocardial infarction ventricular tachycardia (n=91). Noninducibility after VT ablation vs. Inducibility after VT ablation was evaluated on Survival free from VT recurrence and cardiac death at 1 year (LVEF >30% subgroup) (p=0.015). Noninducibility after VT ablation improved 1-year survival free from VT recurrence and cardiac death in patients with LVEF >30% (90% vs 65%, P=0.015), but not in those with LVEF ≤30% (31% vs 39%).
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