Outcome of ventricular tachycardia catheter ablation in ischemic heart disease patients using a high-density mapping substrate-based approach: A prospective cohort study.

Introduction And Objective: Radiofrequency catheter ablation (RCA) for ventricular tachycardia (VT) in patients with ischemic heart disease (IHD) is associated with a reduced risk of VT storm and implantable cardioverter defibrillator (ICD) shocks. We aim to report the outcome after a single RCA procedure for VT in patients with IHD using a high-density substrate-based approach.

Methods: We conducted a prospective, observational, single-center and single-arm study involving patients with IHD, referred for RCA procedure for VT using high-density mapping catheters. Substrate mapping was performed in all patients. Procedural endpoints were VT non-inducibility and local abnormal ventricular activities (LAVAs) elimination. The primary end point was survival free from appropriate ICD shocks and secondary end points included VT storm and all-cause mortality.

Results: Sixty-four consecutive patients were included (68±9 years, 95% male, mean ejection fraction 33±11%, 39% VT storms, and 69% appropriate ICD shocks). LAVAs were identified in all patients and VT inducibility was found in 83%. LAVA elimination and non-inducibility were achieved in 93.8% and 60%, respectively. After a mean follow-up of 25±18 months, 90% and 85% of patients are free from appropriate ICD shocks at one and two years, respectively. The proportion of patients experiencing VT storm decreased from 39% to 1.6%. Overall survival was 89% and 84% at one and two years, respectively.

Conclusions: RCA of VT in IHD using a high-density mapping substrate-based approach resulted in a steady freedom of ICD shocks and VT storm.