September 2, 2015Journal of Cardiovascular Electrophysiology
Impact of Substrate‐Based Ablation of Ventricular Tachycardia on Cardiac Mortality in Patients With Implantable Cardioverter‐Defibrillators
Key result
Acute procedural success of substrate-based ablation (LAVA elimination and VT noninducibility) was associated with a lower risk of all-cause mortality (HR 0.32; 95% CI 0.17-0.60; P<0.001).
Why the study?
Does acute procedural success of substrate-based VT ablation reduce mortality and VT recurrence in ICD recipients with ischemic or nonischemic dilated cardiomyopathy?
Population
195 ICD recipients with ischemic or nonischemic dilated cardiomyopathy, mean age 65 ± 11 years.
Comparison
Substrate-based ablation targeting elimination… vs Substrate-based ablation resulting in ablation…
Design
Cohort
Follow-up
median 23 months
Authors
Discussion
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Implication
Supports acute success as ablation target in cardiomyopathy; leaves open causal mortality benefit in randomized trials.
Study Design
Type
Cohort (n=195)
Structured PICO
Does acute procedural success of substrate-based VT ablation reduce mortality and VT recurrence in ICD recipients with ischemic or nonischemic dilated cardiomyopathy?
P
Population
195 ICD recipients with ischemic or nonischemic dilated cardiomyopathy, mean age 65 ± 11 years.
I
Intervention
Substrate-based ablation targeting elimination of local abnormal ventricular activities (LAVA) resulting in acute procedural success (defined as elimination of all identified LAVA in addition to the lack of VT inducibility).
C
Comparator
Substrate-based ablation resulting in ablation failure (failure to achieve elimination of all LAVA and lack of VT inducibility).
O
Outcome
All-cause mortalityhard clinical
Main Result
Effect estimate: HR 0.32 (95% CI 0.17-0.60)
p-value: p=<0.001
Successful elimination of LAVA and VT noninducibility during substrate-based ablation is associated with significantly reduced mortality and VT recurrence, particularly in patients with severe heart failure (LVEF ≤ 35% and NYHA class III/IV).
Cite This Study
Komatsu et al. (2015) conducted a cohort in Ventricular tachycardia in patients with implantable cardioverter-defibrillators (n=195). Substrate-based ablation with acute procedural success (LAVA elimination and VT noninducibility) vs. Ablation failure was evaluated on All-cause mortality (HR 0.32, 95% CI 0.17-0.60, p=<0.001). Acute procedural success of substrate-based ablation (LAVA elimination and VT noninducibility) was associated with a lower risk of all-cause mortality (HR 0.32; 95% CI 0.17-0.60; P<0.001).