Key result
Prior anterior MI shows no mortality difference versus inferior MI after ischemic VT ablation.
Why the study?
Outcomes of ischemic VT ablation may differ depending on whether patients had a previous anterior versus inferior myocardial infarction.
Does infarct localization (anterior vs inferior MI) affect outcomes after ischemic VT ablation?
Cohort (n=152)
No
Does infarct localization (anterior vs inferior MI) affect outcomes after ischemic VT ablation?
Effect estimate: HR 1.104 (95% CI 0.55-2.23)
Absolute Event Rate: 39% vs 24%
p-value: p=0.78
Patients with inferior MI appear to have better outcomes regarding survival, ICD shocks, and re-ablation after ischemic VT ablation, but this is driven by better baseline ejection fraction rather than infarct location itself.
Infarct location does not independently affect mortality after ischemic VT ablation; leaves open whether it influences recurrence or ICD therapies beyond ejection fraction.
BACKGROUND: Outcome of ischemic VT ablation may differ between patients with previous myocardial infarction (MI) in relation to infarct localization. METHODS: We analyzed procedural data, acute and long-term outcomes of 152 consecutive patients (139 men, mean age 67 ± 9 years) with previous anterior or inferior MI who underwent ischemic VT ablation at our institution between January 2010 and October 2015. RESULTS: More patients had a history of inferior MI (58%). Mean ejection fraction was significantly lower in anterior MI patients (28 ± 10% vs. 34 ± 10%, p < 0.001). NYHA class and presence of comorbidities were not different between the groups. Indication for the procedure was electrical storm in 43% of patients, and frequent implantable cardioverter defibrillator (ICD) therapies in 57%, and did not differ significantly between anterior and inferior MI patients. A mean of 3 ± 2 VT morphologies were inducible, with a trend towards more VT in the anterior MI group (3.1 ± 2.2 vs. 2.6 ± 1.9, p = 0.18). Procedural parameters and acute success did not differ between the groups. During a mean follow-up of 3 ± 2 years, more anterior MI patients had undergone a re-ablation (49% vs. 33%, p = 0.09, Chi-square test). There was a trend towards more ICD shocks in patients with previous anterior MI (46% vs. 34%). After adjusting for risk factors and ejection fraction, multivariable Cox regression analyses showed no significant difference in mortality (p = 0.78) and cardiovascular mortality between infarct localizations (p = 0.6). CONCLUSION: Clinical characteristics of patients with anterior and inferior MI are similar except for ejection fraction. Patients with inferior MI appear to have better outcome regarding survival, ICD shocks and re-ablation, but this appears to be related to better ejection fraction when compared with anterior MI.
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Wasmer et al. (2020) conducted a cohort in Ischemic cardiomyopathy with previous anterior or inferior myocardial infarction and ventricular tachycardia (n=152). Catheter ablation for VT in anterior myocardial infarction vs. Catheter ablation for VT in inferior myocardial infarction was evaluated on Total mortality (adjusted for ejection fraction and risk factors) (HR 1.104, 95% CI 0.55-2.23, p=0.78). In patients undergoing ischemic VT ablation, there was no significant difference in total mortality between those with previous anterior versus inferior myocardial infarction after adjusting for ejection fraction (HR 1.104).
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