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Outcomes of a combined vs non-combined endo-epicardial ventricular tachycardia ablation strategy

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Abstract

Background

Direct comparisons of combined (C-ABL) and non-combined (NC-ABL) endo-epicardial ventricular tachycardia (VT) ablation outcomes are scarce. We aimed to investigate the long-term clinical efficacy and safety of these 2 strategies in ischemic heart disease (IHD) and non-ischemic cardiomyopathy (NICM) populations.

Methods

Multicentric observational registry included 316 consecutive patients who underwent catheter ablation for drug-resistant VT between January 2008 and July 2019. Primary and secondary efficacy endpoints were defined as VT-free survival and all-cause death after ablation. Safety outcomes were defined by 30-day mortality and procedure-related complications.

Results

Most of the patients were male (85%), with IHD (67%) and mean age of 63 ± 13 years. During a mean follow-up of 3 ± 2 years, 117 (37%) patients had VT recurrence and 73 (23%) died. Multivariate survival analysis identified electrical storm (ES) at presentation, IHD, left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) functional class III / IV, and C-ABL as independent predictors of VT recurrence. In 135 patients undergoing repeated procedures, only C-ABL and ES were independent predictors of relapse. The identified independent predictors of mortality were C-ABL, ES, LVEF, age, and NYHA class III / IV. C-ABL survival benefit was only seen in patients with a previous ablation (P for interaction = 0.04). Mortality at 30 days was similar between NC-ABL and C-ABL (4% vs. 2%, respectively, P = 0.777), as was complication rate (10.3% vs. 15.1%, respectively, P = 0.336).

Conclusion

A combined or sequential endo-epicardial VT ablation strategy was associated with lower VT recurrence and lower all-cause death in IHD and NICM patients undergoing repeated procedures. Both approaches seemed equally safe.

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Change history

  • 09 May 2022

    Springer Nature’s version of this paper was updated: In the first line of the abstract conclusion, “TV ablation strategy” should instead be “VT ablation strategy".

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Authors and Affiliations

  1. Cardiology and Eletrophysiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Reinaldo Dos Santos, 2790-134, Carnaxide, Portugal

    Daniel Matos, Pedro Adragão, Pedro Freitas, Francisco Costa, António Miguel Ferreira, Pedro Carmo, Francisco Morgado, Diogo Cavaco & Miguel Mendes

  2. Heart Institute (Incor), University of São Paulo Medical School, São Paulo, Brazil

    Cristiano Pisani, Vinicius Hatanaka, Muhiedinne Chokr, Carina Hardy, Sissy Laura & Maurício Scanavacca

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  1. Daniel Matos
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  2. Pedro Adragão
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Correspondence to Daniel Matos.

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All human and animal studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Matos, D., Adragão, P., Pisani, C. et al. Outcomes of a combined vs non-combined endo-epicardial ventricular tachycardia ablation strategy. J Interv Card Electrophysiol 66, 87–94 (2023). https://doi.org/10.1007/s10840-022-01175-3

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  • DOI: https://doi.org/10.1007/s10840-022-01175-3

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