title: Long-term benefit of first-line peri-implantable cardioverter-defibrillator implant ventricular tachycardia-substrate ablation in secondary prevention patients.
abstract: OBJECTIVE
  This study assessed the benefit of peri-implantable cardioverter-defibrillator implant ventricular tachycardia (VT)-substrate ablation in patients with structural heart disease (SHD).
  
  
  RESULTS
  Patients with SHD and indication for secondary prevention ICD implant were prospectively included. Patients presenting with incessant and/or slow VT or frequent (≥2) VT episodes who underwent peri-ICD VT-substrate ablation (the scar dechannelling technique) were compared with those who received ICD alone and did not meet ablation criteria. The primary endpoint was any sustained VT/ICD therapy during follow-up. Of 206 patients included (43.2% non-ischaemic), 70 were assigned to ablation and 136 received ICD implant alone. During a mean follow-up of 45.6 ± 24.7 months, the primary endpoint was more frequent in the non-ablation group (47.1 vs. 22.9%; P< 0.0001). Higher VT recurrence-free survival rate [log-rank P= 0.001; HR = 0.42 (0.24-0.73), P= 0.002] and ICD shock-free survival rate [log-rank P= 0.007; HR = 0.36 (0.17-0.78); P = 0.01] were observed in the ablation group. Higher relative risk reduction was observed in ischaemic [HR = 0.38 (0.18-0.83); P = 0.015] vs. non-ischaemic patients [HR = 0.49 (0.23-1.01); P = 0.08]. Patients with left ventricular ejection fraction (LVEF) <35% showed no differences in VT recurrence between treatment groups (log-rank P = 0.213) although VT burden during follow-up was lower in the ablation group [median (interquartile range) 1 (1-3) vs. 4 (1-10) VT episodes; P = 0.05].
  
  
  CONCLUSIONS
  First-line peri-ICD implant VT-substrate ablation was associated with decreased VT recurrence and ICD shocks during long-term follow-up in patients with SHD and indication for secondary prevention ICD implant, especially in ischaemic patients. In patients with LVEF <35%, no benefit was observed in terms of VT recurrence-free survival, although VT burden during follow-up was lower in the ablation group.
authors.forename: Juan
authors.initials: J
authors.lastname: Acosta
authors.forename: Nuno
authors.initials: N
authors.lastname: Cabanelas
authors.forename: Diego
authors.initials: D
authors.lastname: Penela
authors.forename: Juan
authors.initials: J
authors.lastname: Fernández-Armenta
authors.forename: David
authors.initials: D
authors.lastname: Andreu
authors.forename: Roger
authors.initials: R
authors.lastname: Borràs
authors.forename: Viatcheslav
authors.initials: V
authors.lastname: Korshunov
authors.forename: Mario
authors.initials: M
authors.lastname: Cabrera
authors.forename: Francesca
authors.initials: F
authors.lastname: Vasanelli
authors.forename: Elena
authors.initials: E
authors.lastname: Arbelo
authors.forename: Eduard
authors.initials: E
authors.lastname: Guasch
authors.forename: Mikel
authors.initials: M
authors.lastname: Martínez
authors.forename: Jose M
authors.initials: JM
authors.lastname: Tolosana
authors.forename: Lluis
authors.initials: L
authors.lastname: Mont
authors.forename: Antonio
authors.initials: A
authors.lastname: Berruezo
mesh_terms: D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D017147:Defibrillators, Implantable; D018572:Disease-Free Survival; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D055502:Secondary Prevention / Q000295:instrumentation*; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: Catheter ablation; Secondary prevention; Ventricular tachycardia