Better outcome of ablation for sustained outflow-tract ventricular tachycardia when tachycardia is inducible.

Choi, Eue-Keun; Kumar, Saurabh; Nagashima, Koichi; Lin, Kaity Y; Barbhaiya, Chirag R; Chinitz, Jason S; Enriquez, Alan D; Helmbold, Alan F; Baldinger, Samuel Hannes; Tedrow, Usha B; Koplan, Bruce A; Michaud, Gregory F; John, Roy M; Epstein, Laurence M; Stevenson, William G (2015). Better outcome of ablation for sustained outflow-tract ventricular tachycardia when tachycardia is inducible. Europace, 17(10), pp. 1571-1579. Oxford University Press 10.1093/europace/euv064

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AIMS

In patients presenting with spontaneous sustained ventricular tachycardia (VT) from the outflow-tract region without overt structural heart disease ablation may target premature ventricular contractions (PVCs) when VT is not inducible. We aimed to determine whether inducibility of VT affects ablation outcome.

METHODS AND RESULTS

Data from 54 patients (31 men; age, 52 ± 13 years) without overt structural heart disease who underwent catheter ablation for symptomatic sustained VT originating from the right- or left-ventricular outflow region, including the great vessels. A single morphology of sustained VT was inducible in 18 (33%, SM group) patients, and 11 (20%) had multiple VT morphologies (MM group). VT was not inducible in 25 (46%) patients (VTni group). After ablation, VT was inducible in none of the SM group and in two (17%) patients in the MM group. In the VTni group, ablation targeted PVCs and 12 (48%) patients had some remaining PVCs after ablation. During follow-up (21 ± 19 months), VT recurred in 46% of VTni group, 40% of MM inducible group, and 6% of the SM inducible group (P = 0.004). Analysis of PVC morphology in the VTi group further supported the limitations of targeting PVCs in this population.

CONCLUSION

Absence of inducible VT and multiple VT morphologies are not uncommon in patients with documented sustained outflow-tract VT without overt structural heart disease. Inducible VT is associated with better outcomes, suggesting that attempts to induce VT to guide ablation are important in this population.

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