Radiofrequency catheter ablation of ventricular tachycardia in structural heart disease: single team experience with follow-up upto 5 years

Radiofrequency catheter ablation (RFA) of ventricular tachycardia (VT) has significantly evolved over the past few decades.Ablation of idiopathic VT in the absence of structural heart disease is now well accepted as a safe and effective procedure.In contrast, ablation of VT with underlying structural heart disease is more challenging 1, mainly because of the heterogeneous reentrant circuits involved and the location of the circuit deep inside the scar.Experience and understanding about VT in structural heart disease has increased over last few years.From the fundamental understanding of the reentrant mechanism in scar-mediated VT to the advent and routine implementation of electroanatomic mapping, catheter ablation has emerged from a palliative last-resort therapy to a more preemptive strategy for patients at risk for arrhythmia recurrence 2.Introduction: Catheter ablation of ventricular tachycardia (VT) in structural heart disease has significantly evolved over the past few decades.We present our experience of VT ablation in such patients over last five years. Methods and Results:Out of 38 cases of VT ablation in patients with structural heart disease done during last five years, 18 had chronic myocardial scar, 2 had recent myocardial infarction, 1 dilated cardiomyopathy and 17 ARVD/C.Substrate modifications was performed as first step in majority of patients by using 3D electroanatomical system (NavX, St. Jude Medical, USA).VT induction was tried after substrate modification.End point of ablation was non-inducibility of all VTs.Failure of RFA was seen in no patient.Partial success of RFA was seen in 2 and in 36 (95%) the procedure was fully successful.Fifteen patients already had an ICD implanted whereas 20 patients underwent ICD implantation after the procedure.Median Follow-up available is for 38 months.Four patients had recurrence of VT identified by the ICD.No patient had sudden cardiac death.One patient of ARVD/C had progressive RV failure. Conclusion:VT ablation in patients with underlying structural heart disease significantly reduces the recurrence of VT episodes.It plays an important role in reducing the number of ICD therapies.