title: Better outcome of ablation for sustained outflow-tract ventricular tachycardia when tachycardia is inducible.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea choiek17@snu.ac.kr.
authors.forename: Eue-Keun
authors.initials: EK
authors.lastname: Choi
authors.affiliation: Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Koichi
authors.initials: K
authors.lastname: Nagashima
authors.affiliation: Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Kaity Y
authors.initials: KY
authors.lastname: Lin
authors.affiliation: Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Barbhaiya
authors.affiliation: Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Chinitz
authors.affiliation: Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Enriquez
authors.affiliation: Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Alan F
authors.initials: AF
authors.lastname: Helmbold
authors.affiliation: Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Samuel H
authors.initials: SH
authors.lastname: Baldinger
authors.affiliation: Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Usha B
authors.initials: UB
authors.lastname: Tedrow
authors.affiliation: Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Koplan
authors.affiliation: Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Michaud
authors.affiliation: Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Roy M
authors.initials: RM
authors.lastname: John
authors.affiliation: Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Laurence M
authors.initials: LM
authors.lastname: Epstein
authors.affiliation: Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: William G
authors.initials: WG
authors.lastname: Stevenson
mesh_terms: D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000592:standards*; D004562:Electrocardiography / Q000145:classification*; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D017180:Tachycardia, Ventricular / Q000601:surgery*; D016896:Treatment Outcome; D018879:Ventricular Premature Complexes / Q000601:surgery*
keywords: Catheter ablation; Inducibility; Ventricular tachycardia