TY - JOUR
T1 - Endocardial Scar-Homogenization With vs Without Epicardial Ablation in VT Patients With Ischemic Cardiomyopathy
AU - Mohanty, Sanghamitra
AU - Trivedi, Chintan
AU - Di Biase, Luigi
AU - Burkhardt, John D.
AU - Della Rocca, Domenico Giovanni
AU - Gianni, Carola
AU - MacDonald, Bryan
AU - Mayedo, Angel
AU - Shetty, Sai Shishir
AU - Zagrodzky, Will
AU - Baqai, Faiz
AU - Bassiouny, Mohamed
AU - Gallinghouse, G. Joseph
AU - Horton, Rodney
AU - Al-Ahmad, Amin
AU - Natale, Andrea
N1 - Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/4
Y1 - 2022/4
N2 - Objectives: In this study, the authors investigated the ablation success of scar homogenization with combined (epicardial + endocardial) vs endocardial-only approach for ventricular tachycardia (VT) in patients with ischemic cardiomyopathy (ICM) at 5 years of follow-up. Background: Best ablation approach to achieve long-term success rate in VT patients with ICM is not known yet. Methods: Consecutive ICM patients undergoing VT ablation at our center were classified into group 1: endocardial + epicardial scar homogenization and group 2: endocardial scar homogenization. Patients with previous open heart surgery were excluded. Epicardial ablation was performed despite being noninducible after endocardial ablation in all group 1 patients. All patients underwent bipolar substrate mapping with standard scar settings defined as normal tissue >1.5 mV and severe scar <0.5 mV. Noninducibility of monomorphic VT was the procedural endpoint in both groups. Patients were followed up every 4 months for 5 years with implantable device interrogations. Results: A total of 361 patients (group 1: n = 70 and group 2: n = 291) were included in the study. At 5 years, 81.4% (n = 57/70) patients from group 1 and 66.3% (n = 193/291) from group 2 were arrhythmia-free (P = 0.01) Of those patients, 26 of 57 (45.6%) and 172 of 193 (89.1%) from group 1 and group 2 respectively were on anti-arrhythmic drugs (AAD) (log-rank P < 0.001). After adjusting for age, sex, and obstructive sleep apnea, endo-epicardial scar homogenization was associated with a significant reduction in arrhythmia-recurrence (HR: 0.48; 95% CI: 0.27-0.86; P = 0.02). Conclusions: In this series of patients with ICM and VT, epicardial substrate was detected in all group 1 patients despite being noninducible after endocardial ablation. Moreover, combined endo-epicardial scar homogenization was associated with a significantly higher success rate at 5 years of follow-up and a substantially lower need for antiarrhythmic drugs after the procedure compared with the endocardial ablation alone.
AB - Objectives: In this study, the authors investigated the ablation success of scar homogenization with combined (epicardial + endocardial) vs endocardial-only approach for ventricular tachycardia (VT) in patients with ischemic cardiomyopathy (ICM) at 5 years of follow-up. Background: Best ablation approach to achieve long-term success rate in VT patients with ICM is not known yet. Methods: Consecutive ICM patients undergoing VT ablation at our center were classified into group 1: endocardial + epicardial scar homogenization and group 2: endocardial scar homogenization. Patients with previous open heart surgery were excluded. Epicardial ablation was performed despite being noninducible after endocardial ablation in all group 1 patients. All patients underwent bipolar substrate mapping with standard scar settings defined as normal tissue >1.5 mV and severe scar <0.5 mV. Noninducibility of monomorphic VT was the procedural endpoint in both groups. Patients were followed up every 4 months for 5 years with implantable device interrogations. Results: A total of 361 patients (group 1: n = 70 and group 2: n = 291) were included in the study. At 5 years, 81.4% (n = 57/70) patients from group 1 and 66.3% (n = 193/291) from group 2 were arrhythmia-free (P = 0.01) Of those patients, 26 of 57 (45.6%) and 172 of 193 (89.1%) from group 1 and group 2 respectively were on anti-arrhythmic drugs (AAD) (log-rank P < 0.001). After adjusting for age, sex, and obstructive sleep apnea, endo-epicardial scar homogenization was associated with a significant reduction in arrhythmia-recurrence (HR: 0.48; 95% CI: 0.27-0.86; P = 0.02). Conclusions: In this series of patients with ICM and VT, epicardial substrate was detected in all group 1 patients despite being noninducible after endocardial ablation. Moreover, combined endo-epicardial scar homogenization was associated with a significantly higher success rate at 5 years of follow-up and a substantially lower need for antiarrhythmic drugs after the procedure compared with the endocardial ablation alone.
KW - endocardial ablation
KW - epicardial ablation
KW - ischemic cardiomyopathy
KW - ventricular tachycardia
UR - http://www.scopus.com/inward/record.url?scp=85127906012&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85127906012&partnerID=8YFLogxK
U2 - 10.1016/j.jacep.2021.12.011
DO - 10.1016/j.jacep.2021.12.011
M3 - Article
C2 - 35246406
AN - SCOPUS:85127906012
SN - 2405-500X
VL - 8
SP - 453
EP - 461
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 4
ER -