Late potentials abolition reduces ventricular tachycardia recurrence after ablation especially in higher‐risk patients with a chronic total occlusion in an infarct‐related artery

Introduction Late potentials (LP) abolition is recognized as an effective strategy for substrate ablation of ventricular tachycardia (VT). The presence of a chronic total occlusion in a coronary artery responsible for a previous myocardial infarction (infarct related artery CTO, IRA‐CTO) is emerging...

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Published in:Journal of cardiovascular electrophysiology 2018-08, Vol.29 (8), p.1119-1124
Main Authors: Di Marco, Andrea, Oloriz Sanjuan, Teresa, Paglino, Gabriele, Baratto, Francesca, Vergara, Pasquale, Bisceglia, Caterina, Trevisi, Nicola, Sala, Simone, Marzi, Alessandra, Gulletta, Simone, Cireddu, Manuela, Anguera, Ignasi, Della Bella, Paolo
Format: Article
Language:English
Subjects:
Ablation
Angiography
Cardiac arrhythmia
Coronary artery
coronary chronic total occlusion
Electrocardiography
Heart attacks
Infarction
ischemic cardiomyopathy
late potentials abolition
Myocardial infarction
Occlusion
Population studies
radiofrequency ablation
Substrates
Tachycardia
Ventricle
ventricular tachycardia
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Summary:Introduction Late potentials (LP) abolition is recognized as an effective strategy for substrate ablation of ventricular tachycardia (VT). The presence of a chronic total occlusion in a coronary artery responsible for a previous myocardial infarction (infarct related artery CTO, IRA‐CTO) is emerging as a predictor of ventricular arrhythmias and VT recurrence after ablation. We sought to analyze the effects of LP abolition, focusing on the high‐risk subgroup of patients with IRA‐CTO. Methods and results This was a single‐center, observational study that screened all patients with prior myocardial infarction and clinical VT, referred for VT ablation at San Raffaele Hospital between 2010 and June 2013. Patients were then included in the study if they had a coronary diagnostic angiography (without revascularization) performed during the index hospitalization. The main endpoint was VT recurrence after ablation. Eighty‐four patients formed the population of the study. An IRA‐CTO was present in 47 patients (56%) and the presence of an IRA‐CTO was a predictor of VT recurrence (HR 3.7, P = 0.005). LP were observed in 51 patients and successfully abolished in 38 cases. LP abolition was associated with lower VT recurrence especially among patients with IRA‐CTO (24% vs. 65%, P = 0.005). The presence of an IRA‐CTO, in combination with no LP abolition, was the strongest predictor of VT recurrence (HR 4.4, P 
ISSN:1045-3873
1540-8167
DOI:10.1111/jce.13488