A chronic total occlusion in an infarct-related artery independently predicted higher VT recurrence after ablation compared to no occlusion (47% vs 16%; HR 4.05, P=0.004).
Cohort (n=84)
No
Does the presence of a chronic total occlusion in an infarct-related artery predict ventricular tachycardia recurrence in patients with prior myocardial infarction undergoing VT ablation?
The presence of a chronic total occlusion in an infarct-related artery is a strong independent predictor of ventricular tachycardia recurrence after ablation in patients with prior myocardial infarction.
Effect estimate: HR 4.05
Absolute Event Rate: 47% vs 16%
p-value: p=0.004
INTRODUCTION: In patients with a prior myocardial infarction (MI), angiographic predictors of ventricular tachycardia (VT) recurrence after ablation are lacking. Recently, a proarrhythmic effect of a chronic total occlusion (CTO) in a coronary artery has been suggested. METHODS AND RESULTS: A total of 191 patients with prior MI were referred to our Hospital between 2010 and June 2013 for a first ablation of VT. Of these, 84 patients (44%) with stable coronary artery disease that underwent a coronary angiography during the index hospitalization were included in this study. A CTO in an infarct-related artery (IRA-CTO) was present in 47 patients (56%). Patients with and without IRA-CTO did not differ in terms of comorbidities, severity of heart failure, presentation of VT or acute outcome of ablation, that was completely successful in 93% of cases. At electroanatomic mapping, IRA-CTO was associated with greater scar and especially with greater area of border zone (34 cm(2) vs. 19 cm(2) , P = 0.001). Median follow-up was 19 months (IQR 18). At follow-up, patients with IRA-CTO had a significantly higher rate of VT recurrence (47% vs. 16%, P = 0.003). At multivariate analysis, IRA-CTO resulted to be an independent predictor of VT recurrence after ablation (HR 4.05, P = 0.004). CONCLUSIONS: IRA-CTO is an independent predictor of VT recurrence after ablation and identifies a subgroup of patients with high recurrence rate despite a successful procedure. IRA-CTO is associated with greater scars and border zone area; however, this association does not completely justify its proarrhythmic effect.
Marco et al. (Mon,) conducted a cohort in Ventricular tachycardia with prior myocardial infarction (n=84). Chronic total occlusion in an infarct-related artery (IRA-CTO) vs. Absence of IRA-CTO was evaluated on Ventricular tachycardia (VT) recurrence (HR 4.05, p=0.004). A chronic total occlusion in an infarct-related artery independently predicted higher VT recurrence after ablation compared to no occlusion (47% vs 16%; HR 4.05, P=0.004).