title: Noninvasive programmed ventricular stimulation early after ventricular tachycardia ablation to predict risk of late recurrence.
abstract: OBJECTIVE
  The goal of this study was to evaluate the ability of noninvasive programmed stimulation (NIPS) after ventricular tachycardia (VT) ablation to identify patients at high risk of recurrence.
  
  
  BACKGROUND
  Optimal endpoints for VT ablation are not well defined.
  
  
  METHODS
  Of 200 consecutive patients with VT and structural heart disease undergoing ablation, 11 had clinical VT inducible at the end of ablation and 11 recurred spontaneously. Of the remaining 178 patients, 132 underwent NIPS through their implantable cardioverter-defibrillator 3.1 ± 2.1 days after ablation. At 2 drive cycle lengths, single, double, and triple right ventricular extrastimuli were delivered to refractoriness. Clinical VT was defined by comparison with 12-lead electrocardiograms and stored implantable cardioverter-defibrillator electrograms from spontaneous VT episodes. Patients were followed for 1 year.
  
  
  RESULTS
  Fifty-nine patients (44.7%) had no VT inducible at NIPS; 49 (37.1%) had inducible nonclinical VT only; and 24 (18.2%) had inducible clinical VT. Patients with inducible clinical VT at NIPS had markedly decreased 1-year VT-free survival compared to those in whom no VT was inducible (<30% vs. >80%; p = 0.001), including 33% recurring with VT storm. Patients with inducible nonclinical VT only, had intermediate 1-year VT-free survival (65%).
  
  
  CONCLUSIONS
  When patients with VT and structural heart disease have no VT or nonclinical VT only inducible at the end of ablation or their condition is too unstable to undergo final programmed stimulation, NIPS should be considered in the following days to further define risk of recurrence. If clinical VT is inducible at NIPS, repeat ablation may be considered because recurrence over the following year is high.
authors.affiliation: Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Frankel
authors.forename: Stavros E
authors.initials: SE
authors.lastname: Mountantonakis
authors.forename: Erica S
authors.initials: ES
authors.lastname: Zado
authors.forename: Elad
authors.initials: E
authors.lastname: Anter
authors.forename: Rupa
authors.initials: R
authors.lastname: Bala
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Cooper
authors.forename: Rajat
authors.initials: R
authors.lastname: Deo
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dixit
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Epstein
authors.forename: Fermin C
authors.initials: FC
authors.lastname: Garcia
authors.forename: Edward P
authors.initials: EP
authors.lastname: Gerstenfeld
authors.forename: Mathew D
authors.initials: MD
authors.lastname: Hutchinson
authors.forename: David
authors.initials: D
authors.lastname: Lin
authors.forename: Vickas V
authors.initials: VV
authors.lastname: Patel
authors.forename: Michael P
authors.initials: MP
authors.lastname: Riley
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Robinson
authors.forename: Wendy S
authors.initials: WS
authors.lastname: Tzou
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Verdino
authors.forename: David J
authors.initials: DJ
authors.lastname: Callans
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D055502:Secondary Prevention; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome