Noninvasive programmed ventricular stimulation early after ventricular tachycardia ablation to predict risk of late recurrence

David S. Frankel, Stavros E. Mountantonakis, Erica S. Zado, Elad Anter, Rupa Bala, Joshua M. Cooper, Rajat Deo, Sanjay Dixit, Andrew E. Epstein, Fermin C. Garcia, Edward P. Gerstenfeld, Mathew D. Hutchinson, David Lin, Vickas V. Patel, Michael P. Riley, Melissa R. Robinson, Wendy S. Tzou, Ralph J. Verdino, David J. Callans, Francis E. Marchlinski

Research output: Contribution to journalArticlepeer-review

65 Scopus citations

Abstract

Objectives: 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.

Original languageEnglish (US)
Pages (from-to)1529-1535
Number of pages7
JournalJournal of the American College of Cardiology
Volume59
Issue number17
DOIs
StatePublished - Apr 24 2012

Keywords

  • catheter ablation
  • programmed stimulation
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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