title: Substrate-guided ablation of haemodynamically tolerated and untolerated ventricular tachycardia in patients with structural heart disease: effect of cardiomyopathy type and acute success on long-term outcome.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the outcomes of purely substrate-guided ventricular tachycardia (VT) ablation in patients with non-ischaemic dilated cardiomyopathy (NIDCM) and ischaemic cardiomyopathy (ICM) and the impact of acute procedural success on long-term outcome.
  
  
  RESULTS
  One hundred and forty-two patients (65 ± 12 years old, 72% male) with ICM (n = 87) and with NIDCM (n = 55) underwent substrate-guided VT ablation. The ablation approach involved eliminating all LP regions and ablating all scar border zone regions with 10 or more out of 12 pace-matching. All patients were followed with regular implantable defibrillator interrogations for mean 641 ± 301 days. Complete acute success (no inducible VT) was achieved in 60 patients with ICM (69%) and in 29 patients with NIDCM (53%) (P = 0.03). Partial success (elimination of clinical VT only) was obtained in nine patients with ICM (10%) and in four patients with NIDCM (7%) (P = 0.14). Procedural failure (clinical VT still inducible) occurred in 18 patients within the ICM group (21%) and in 22 patients of the NIDCM (40%) (P = 0.04). Overall, 51 patients presented with recurrence of ventricular arrhythmias: 23 in the group with ICM (26%) and 28 in the group with NIDCM (51%) (P = 0.03). Long-term success was related to acute procedural outcome.
  
  
  CONCLUSIONS
  Substrate-guided ablation is an effective approach in the treatment of VT with long-term outcome directly related to acute procedural success. Success rates are significantly lower in patients with NIDCM compared with those with ICM.
authors.affiliation: McGill University Health Centre, Montreal, Quebec, Canada Cardiology Department, Luigi Sacco Hospital, Milan, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Proietti
authors.affiliation: McGill University Health Centre, Montreal, Quebec, Canada Hôpital Sacré-Cœur de Montreal, Quebec, Canada.
authors.forename: Vidal
authors.initials: V
authors.lastname: Essebag
authors.affiliation: Southlake Regional Health Centre, Heart Rhythm Program, Suite 602, 581 Davis Drive, Newmarket, Ontario, Canada L3Y 2P6.
authors.forename: Jessica
authors.initials: J
authors.lastname: Beardsall
authors.affiliation: Southlake Regional Health Centre, Heart Rhythm Program, Suite 602, 581 Davis Drive, Newmarket, Ontario, Canada L3Y 2P6.
authors.forename: Philip
authors.initials: P
authors.lastname: Hache
authors.affiliation: Southlake Regional Health Centre, Heart Rhythm Program, Suite 602, 581 Davis Drive, Newmarket, Ontario, Canada L3Y 2P6.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Pantano
authors.affiliation: Southlake Regional Health Centre, Heart Rhythm Program, Suite 602, 581 Davis Drive, Newmarket, Ontario, Canada L3Y 2P6.
authors.forename: Zaev
authors.initials: Z
authors.lastname: Wulffhart
authors.affiliation: Southlake Regional Health Centre, Heart Rhythm Program, Suite 602, 581 Davis Drive, Newmarket, Ontario, Canada L3Y 2P6.
authors.forename: Rasna
authors.initials: R
authors.lastname: Juta
authors.affiliation: Southlake Regional Health Centre, Heart Rhythm Program, Suite 602, 581 Davis Drive, Newmarket, Ontario, Canada L3Y 2P6.
authors.forename: Bernice
authors.initials: B
authors.lastname: Tsang
authors.affiliation: McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Joza
authors.affiliation: McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Thais
authors.initials: T
authors.lastname: Nascimento
authors.affiliation: McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Vagner
authors.initials: V
authors.lastname: Pegoraro
authors.affiliation: Southlake Regional Health Centre, Heart Rhythm Program, Suite 602, 581 Davis Drive, Newmarket, Ontario, Canada L3Y 2P6.
authors.forename: Yaariv
authors.initials: Y
authors.lastname: Khaykin
authors.affiliation: McGill University Health Centre, Montreal, Quebec, Canada Southlake Regional Health Centre, Heart Rhythm Program, Suite 602, 581 Davis Drive, Newmarket, Ontario, Canada L3Y 2P6 atul.verma@utoronto.ca.
authors.forename: Atul
authors.initials: A
authors.lastname: Verma
mesh_terms: D000368:Aged; D057791:Cardiac Imaging Techniques; D002311:Cardiomyopathy, Dilated / Q000209:etiology*; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000379:methods*; D002921:Cicatrix / Q000209:etiology / Q000601:surgery*; D022062:Electrophysiologic Techniques, Cardiac; D056149:Epicardial Mapping; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications*; D016016:Proportional Hazards Models; D012008:Recurrence; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Cardiomyopathy; Catheter ablation; Outcome; Ventricular tachycardia