Predictive value of programmed ventricular stimulation after catheter ablation of post-infarction ventricular tachycardia.
BACKGROUND
A recent meta-analysis demonstrated a survival benefit in post-infarction patients whose ventricular tachycardia (VT) was rendered noninducible by catheter ablation. Furthermore, patients with noninducible VT had a lower VT recurrence rate than did patients whose VT remained inducible after ablation.


OBJECTIVE
The purpose of this multicenter cohort study was to assess whether noninducibility after VT ablation is independently associated with improved survival.


METHODS
Data from 1,064 patients who underwent VT ablation for post-infarction VT at seven international centers were analyzed. The ablation procedure was considered successful if no VT was inducible at the end of the procedure and unsuccessful if VT remained inducible or if programmed stimulation was not performed at the end of the ablation.


RESULTS
Median follow-up time was 633 days. Noninducibility was independently associated with lower mortality (adjusted hazard ratio: 0.65; 95% confidence interval: 0.53 to 0.79; p<0.001). Atrial fibrillation, diabetes, and age were other independent predictors of higher mortality. Ablation of only the clinical VT in patients who also had inducible, nonclinical VTs was not associated with improved survival.


CONCLUSIONS
Noninducibility after VT ablation in patients with post-infarction VT is independently associated with lower mortality during long-term follow-up.
Division of Cardiology, University of Michigan, Ann Arbor, Michigan.
Miki
M
Yokokawa
Division of Cardiology, University of Michigan, Ann Arbor, Michigan.
Hyungjin Myra
HM
Kim
Division of Cardiology, University of Michigan, Ann Arbor, Michigan.
Kazim
K
Baser
Brigham and Women's Hospital, Boston, Massachusetts.
William
W
Stevenson
Brigham and Women's Hospital, Boston, Massachusetts.
Koichi
K
Nagashima
San Raffaele Hospital, Milan, Italy.
Paolo
P
Della Bella
San Raffaele Hospital, Milan, Italy.
Pasquale
P
Vergara
Division of Cardiology, University Hospital, Leipzig, Germany.
Gerhard
G
Hindricks
Division of Cardiology, University Hospital, Leipzig, Germany.
Arash
A
Arya
Leiden University Medical Center, Leiden, the Netherlands.
Katja
K
Zeppenfeld
Leiden University Medical Center, Leiden, the Netherlands.
Marta
M
de Riva Silva
Division of Cardiology, The Ohio State University, Columbus, Ohio.
Emile G
EG
Daoud
Division of Cardiology, The Ohio State University, Columbus, Ohio.
Sunil
S
Kumar
Asklepios Klinik St. Georg, Hamburg, Germany.
Karl-Heinz
KH
Kuck
Asklepios Klinik St. Georg, Hamburg, Germany.
Ronald
R
Tilz
Asklepios Klinik St. Georg, Hamburg, Germany.
Shibu
S
Mathew
Division of Cardiology, University of Michigan, Ann Arbor, Michigan.
Hamid
H
Ghanbari
Division of Cardiology, University of Michigan, Ann Arbor, Michigan.
Rakesh
R
Latchamsetty
Division of Cardiology, University of Michigan, Ann Arbor, Michigan.
Fred
F
Morady
Division of Cardiology, University of Michigan, Ann Arbor, Michigan. Electronic address: fbogun@med.umich.edu.
Frank M
FM
Bogun
D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology; D017115:Catheter Ablation; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D004558:Electric Stimulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality; D012008:Recurrence; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000401:mortality* / Q000601:surgery*
ablation; mortality