Stepwise ablation strategy in radiofrequency ablation improves acute and long-term outcomes of scar-related ventricular tachycardias

BackgroundThe optimal intervention procedures for scar-related ventricular tachycardia (VT) is still unclear.ObjectiveThis study aimed to compare the acute and long-term outcomes of a stepwise ablation approach targeting critical sites identified through activation mapping during VT or pace mapping followed by substrate ablation with substrate modification alone in patients with scar-related VT.MethodsData of 41 patients with scar-related VTs treated with stepwise ablation (Group 1, n = 29) or substrate modification alone during sinus rhythm (Group 2, n = 12) were retrospectively reviewed. The procedure acute success and long-term success during follow-up were compared.ResultsThere was no statistical difference between the two groups on basic characteristics. Group 1 demonstrated shorter ablation time (P = 0.02), longer VT-free survival rates at a median follow-up of 24.0 months (P = 0.02) and a lower VT recurrence rate (hazard ratio: 0.17, 95% confidence interval: [0.03, 0.93], P = 0.04) compared to Group 2. The acute success and ratio of ablation area to scar area were comparable between the two groups (P ≥ 0.05).ConclusionThe stepwise ablation strategy shows promise for improving acute and long-term outcomes and reducing the recurrence risk in patients with scar-related VT.