Evoked delayed potential ablation for post-myocardial infarction ventricular tachycardia: results from a large prospective multicentre study

EP Europace, vol. 27

Abstract

AIMS: The optimal substrate ablation approach for post-myocardial infarction (MI) ventricular tachycardia (VT) is unknown. Proposed ablation targets are prone to individual interpretation making the ablation outcome potentially operator dependent. Evoked delayed potentials (EDPs) are a well-defined target. Evoked delayed potential ablation was effective in preventing post-MI VT recurrence in a prior study. The aims of this study were to assess long-term outcomes of EDP ablation in a large multicentre cohort of post-MI patients and to compare ablation outcomes between centres with and without prior experience in EDP ablation. METHODS AND RESULTS: Patients with post-MI VT undergoing ablation in one centre performing EDP ablation since 2013 and five centres without prior experience in EDP ablation were prospectively included. A uniform mapping protocol including right ventricular extra-stimulation aiming to EDP identification was followed. Ablation endpoints were EDP elimination and VT non-inducibility. Patients were followed for VT recurrence, mortality, heart transplant, and left ventricular assist device implantation. In total, 130 patients were included. The protocol was successfully performed in 99%, and in 94%, EDPs were identified and ablated. In total, 78% of patients were rendered non-inducible. Ventricular tachycardia-free survival was 78% [95% confidence interval (CI) 71-85] and 71% (95% CI 63-80) at 6 and 12 months, respectively. No difference in VT-free survival was observed among centres with and without prior experience in EPD ablation. CONCLUSION: In a large multicentre prospective cohort of patients with post-MI VT, EDP ablation resulted in good long-term outcomes. Importantly, VT recurrence rates did not differ among centres with and without prior experience in EDP ablation, indicating that this approach can be easily reproduced by operators previously not familiar with the technique.

Authors 13

1. Marta Riva Aachen Department of Cardiology Willem Einthoven Center of Arrhythmia Research and Management

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center , Postbus 9600, Leiden 2300 RC ,

2. Reinder Evertz

   Radboud University Medical Center

   Affiliation as printed

   Department of Cardiology, Radboud University Medical Center , Nijmegen ,

3. Peter Lukáč

   Aarhus University Hospital

   Affiliation as printed

   Department of Cardiology, Aarhus University Hospital , Aarhus ,

4. Lukas Dekker

   Catharina Ziekenhuis

   Affiliation as printed

   Department of Cardiology, Catharina Hospital , Eindhoven ,

5. Yuri Blaauw

   University Medical Center Groningen

   Affiliation as printed

   Department of Cardiology, University Medical Center Groningen , Groningen ,

6. Rachel M.A. ter Bekke

   Maastricht University Medical Centre · Maastricht University

   Affiliation as printed

   Department of Cardiology. Maastricht University Medical Center, Cardiovascular Research Institute Maastricht , Maastricht ,

7. Yoshitaka Kimura Aachen Department of Cardiology Willem Einthoven Center of Arrhythmia Research and Management

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center , Postbus 9600, Leiden 2300 RC ,

8. Rypko J. Beukema

   Radboud University Medical Center

   Affiliation as printed

   Department of Cardiology, Radboud University Medical Center , Nijmegen ,

9. Alexandre J. Ouss

   Catharina Ziekenhuis

   Affiliation as printed

   Department of Cardiology, Catharina Hospital , Eindhoven ,

10. Bart A. Mulder

    University Medical Center Groningen

    Affiliation as printed

    Department of Cardiology, University Medical Center Groningen , Groningen ,

11. Kevin Vernooy

    Maastricht University Medical Centre · Maastricht University

    Affiliation as printed

    Department of Cardiology. Maastricht University Medical Center, Cardiovascular Research Institute Maastricht , Maastricht ,

12. Adrianus P. Pieter Wijnmaalen Aachen Department of Cardiology Willem Einthoven Center of Arrhythmia Research and Management

    Leiden University Medical Center

    Affiliation as printed

    Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center , Postbus 9600, Leiden 2300 RC ,

13. Katja Zeppenfeld corresponding Aachen Department of Cardiology Willem Einthoven Center of Arrhythmia Research and Management

    Leiden University Medical Center

    Affiliation as printed

    Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center , Postbus 9600, Leiden 2300 RC ,