Long-term outcome of catheter ablation in post-infarction recurrent ventricular tachycardia.

OBJECTIVES: Severe LV dysfunction and advanced age are associated with VT recurrence after catheter ablation in patients with post-infarction drug-refractory VT. We present retrospective analysis of long-term outcome after single and repeat VT ablation procedures in patients with ischemic heart disease.

DESIGN: Patients with recurrent VT post infarction who underwent catheter ablation between 2006 and 2017 in Isala Heart Centre were retrospectively analyzed. Univariate and multivariate analysis were used to identify predictors of arrhythmia recurrence post ablation. Patients were allocated to subgroups based on LVEF: severe (< 30%), moderate (30-40%) and mild LV dysfunction (41-51%) and analyzed with log rank test.

RESULTS: A total of 144 patients were included. Two years VT free survival after a single procedure was 56,6% with median follow-up 46 [17-78] months. Recurrence of VT postablation wash high among patients with an old anteroseptal MI and LVEF <30% with multiple morphologies of inducible VTs, indicating an extensive and complex substrate. Patients who underwent repeat ablations (27.1%) had significant more often LV aneurysms (20.5% vs 7.6%, p = 0.03) and electrical storms (38.5% vs 21.9%, p = 0.04). VT free survival was higher in patients with LVEF 41-51% compared to LVEF <30% (71.4% vs 47.8%, p = 0.01). In multivariate analysis, LVEF <30% (vs 41-51%) was an independent predictor of arrhythmia recurrence (HR =2.16, CI 1.15-4.06, P = 0.02).

CONCLUSIONS: In patients with ischemic VT, success rate of ablation was highest among patients with preserved LV function and recurrent VT and ES was highest among patients with severe LV dysfunction after single and multiple ablation procedures.