What is the clinical evidence from this study?

Study design: Cohort. Population: Ventricular tachycardia with structural heart disease (n=199). Intervention: VT catheter ablation (patients without septal substrate) vs. VT catheter ablation (patients with septal substrate). Primary outcome: Occurrence of any sustained ventricular arrhythmia (VT or VF) during follow-up (p=0.069).

October 15, 2021Open Access

Acute and long-term outcomes of VT radiofrequency catheter ablation in patients with versus without an intramural septal substrate

Key Result

VT catheter ablation in patients without a septal substrate resulted in a non-significant trend toward lower VT/VF recurrence compared to patients with a septal substrate (25% vs 39%, p=0.069).

Study Design

Type

Cohort (n=199)

Multicenter

Structured PICO

Does the presence of an intramural septal substrate reduce the efficacy of VT radiofrequency catheter ablation in patients with structural heart disease?

Population

199 consecutive patients with structural heart disease (SHD) undergoing ventricular tachycardia (VT) ablation, mean age 64.2 ± 13.0 years, 89% male, 55% ischemic cardiomyopathy.

Intervention

Radiofrequency catheter ablation in patients with an intramural septal substrate

Comparator

Radiofrequency catheter ablation in patients without an intramural septal substrate

Outcome

Acute procedural success (elimination of all inducible VTs)

The presence of an intramural septal substrate in patients with structural heart disease is associated with significantly lower acute procedural success during VT ablation.

Main Result

Absolute Event Rate: 25% vs 39%

p-value: p=0.069

Limitations

Retrospective study design with potential inclusion bias
Empiric bipolar voltage cut-off values used uniformly for different catheter types
8% of patients lost to follow-up
Sample size and follow-up duration may be insufficient to demonstrate significant association

Abstract

INTRODUCTION: Aim of this study was to evaluate efficacy and safety of ventricular tachycardia (VT) catheter ablation in patients with structural heart disease (SHD) in relation to the presence of an intramural septal substrate. METHODS: Consecutive patients undergoing VT ablation between January 2019 and October 2020 were included. All patients were stratified based on the presence of relevant septal substrate and freedom from VT recurrences were analyzed. RESULTS: In total, 199 consecutive patients (64.2 ± 13.0 years; 89% male; 55% ischemic cardiomyopathy (ICM)) undergoing VT ablation were included. 129/199 patients (65%) showed significant septal substrate (55/90 patients (61%) with non-ischemic cardiomyopathy (NICM) compared to 74/109 patients (68%) with ICM; p = 0.37). Acute procedural success with elimination of all inducible VTs was achieved in 66/70 patients (94%) without and in 103/129 patients (80%) with a septal substrate (p = 0.007). In the cohort including patients with a clinical FU, 15/60 patients (25%) without a septal substrate and 48/123 patients (39%) with a septal substrate experienced VT recurrence during a FU of 8.1 ± 5.9 months (p = 0.069). CONCLUSION: Presence of septal VT substrate in patients with a structural heart disease or coronary artery disease is common. Acute success of VT catheter ablation was significantly higher and mid-term success tended to be higher in patients without a septal substrate.

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