Late Potentials Abolition as an Additional Technique for Reduction of Arrhythmia Recurrence in Scar Related Ventricular Tachycardia Ablation

• Published in: Journal of cardiovascular electrophysiology 2012-06, Vol.23 (6), p.621-627
• Main Authors: VERGARA, PASQUALE, TREVISI, NICOLA, RICCO, ANNALISA, PETRACCA, FRANCESCO, BARATTO, FRANCESCA, CIREDDU, MANUELA, BISCEGLIA, CATERINA, MACCABELLI, GIUSEPPE, DELLA BELLA, PAOLO
• Format: Article
• Language: English
• Subjects: Action Potentials; Aged; Cardiac Pacing, Artificial; Cardiomyopathy, Dilated - complications; Cardiomyopathy, Dilated - physiopathology; catheter ablation; Catheter Ablation - adverse effects; Catheter Ablation - methods; Chi-Square Distribution; Coronary Artery Disease - complications; Coronary Artery Disease - physiopathology; electroanatomical mapping; Electrophysiologic Techniques, Cardiac; epicardial ablation; Feasibility Studies; Female; Heart Ventricles - pathology; Heart Ventricles - physiopathology; Heart Ventricles - surgery; Humans; Italy; late potentials; Male; Middle Aged; Predictive Value of Tests; Risk Assessment; Risk Factors; Secondary Prevention; Tachycardia, Ventricular - diagnosis; Tachycardia, Ventricular - etiology; Tachycardia, Ventricular - physiopathology; Tachycardia, Ventricular - surgery; Time Factors; Treatment Outcome; ventricular tachycardia; Voltage-Sensitive Dye Imaging
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1111/j.1540-8167.2011.02246.x

Late Potentials Ventricular Tachycardia Ablation. Rationale: To evaluate the efficacy of radiofrequency ventricular tachycardia (VT) ablation targeting complete late potential (LP) activity. Methods and Results: Sixty‐four consecutive patients (pts) with recurrent VTs and coronary artery disease or idiopathic dilated cardiomyopathy were evaluated. Fifty patients (47 male; 66.2 ± 10.1 years) had LPs at electroanatomical mapping; 35 patients had at least 1 VT inducible at basal programmed stimulation. After substrate mapping, radiofrequency ablation was performed with the endpoint of all LPs abolition. LPs could not be abolished in 5 patients despite extensive ablation, in 1 patient because of localization near an apical thrombus, and in 2 patients because of possible phrenic nerve injury. At the end of procedure, prevention of VT inducibility was achieved in 25 of 35 patients (71.4%) with previously inducible VT; VT was still inducible in 5 of 8 patients with incomplete LP abolition; and in 5 of 42 patients (16.1%) with complete LP abolition (P < 0.01). After a follow‐up of 13.4 ± 4.0 months, 10 patients (20.0%) had VT recurrences and one of them died after surgical VT ablation; VT recurrence was 9.5% in patients with LPs abolition (4/42 pts) and 75.0% (6/8 pts) in those with incomplete abolition [positive predictive value (PPV): 75%, negative predictive value (NPV): 90.4%, sensibility: 60.0%, and specificity: 95.0%, P < 0.0001); although it was 12.5% (5/40 pts) in patients without inducibility VT after the ablation, and 50% (5/10 pts) in those with inducible VT (PPV: 50%, NPV: 87.5%, sensitivity: 50.0%, and specificity: 87.5%, P = 0.008). Conclusions: LP abolition is an effective endpoint of VT ablation and its prognostic value compares favorably to that achieved by programmed electrical stimulation. (J Cardiovasc Electrophysiol, Vol. 23, pp. 621–627, June 2012)