Author + information
- Received January 4, 2019
- Revision received March 7, 2019
- Accepted March 14, 2019
- Published online June 17, 2019.
- Daniele Muser, MD,
- Tatsuya Hayashi, MD,
- Simon A. Castro, MD,
- Gregory E. Supple, MD,
- Robert D. Schaller, DO,
- Pasquale Santangeli, MD, PhD,
- Jeffrey Arkles, MD,
- Ramanan Kumareswaran, MD,
- Saman Nazarian, MD, PhD,
- Rajat Deo, MD,
- David Lin, MD,
- Sanjay Dixit, MD,
- Andrew E. Epstein, MD,
- David J. Callans, MD,
- Francis E. Marchlinski, MD and
- David S. Frankel, MD∗ ()
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- ↵∗Address for correspondence:
Dr. David S. Frankel, Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Hospital of the University of Pennsylvania, 3400 Spruce Street, 9 Founders Pavilion, Philadelphia, Pennsylvania 19104.
Objectives This study sought to determine the impact of repeat catheter ablation (CA) prior to hospital discharge based on inducibility of clinical ventricular tachycardia (VT) during noninvasive programmed ventricular stimulation (NIPS).
Background Inducibility of clinical VT during NIPS performed several days after CA identifies patients at high risk of recurrence. The impact of NIPS-guided repeat CA has not been reported.
Methods Consecutive patients with structural heart disease undergoing CA of VT followed by NIPS were studied. Clinical VT was defined by comparison with 12-lead electrocardiograms and stored implantable cardioverter-defibrillator electrograms from spontaneous VT episodes. Among those with inducible clinical VT at NIPS, VT-free survival was compared between those in whom ablation was repeated (group 1) versus those in whom ablation was not repeated (group 2) prior to hospital discharge.
Results Among 469 patients (64 ± 12 years of age; 85% males; 60% ischemic), 216 patients (46%) underwent NIPS 3 days (interquartile range: 2 to 4 days) after CA. Clinical VT was induced in 45 patients (21%). Among those 45, CA was repeated in 11 patients (24%). There were no significant differences in baseline clinical or index CA characteristics between groups 1 and 2. Over a median 36-month follow-up, only 1 patient (9%) in group 1 experienced VT recurrence compared to 24 patients (71%) in group 2 (p < 0.01). In univariate Cox regression, repeat CA guided by NIPS (hazard ratio: 0.07; 95% confidence interval: 0.01 to 0.58; p = 0.01) was the only predictor of VT-free survival.
Conclusions In patients with inducible clinical VT during post-ablation NIPS, repeat CA was associated with significantly lower risk of subsequent recurrence.
Supported by the Pennsylvania Steel Company EP Research Fund. Dr. Arkles is a consultant for Biosense Webster. Dr. Nazarian has received funding from and is a consultant for Siemens, ImriCor, Biosense Webster, and CardioSolv; and he has been principle investigator for a national St. Jude Medical study. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC:Clinical Electrophysiology author instructions page.
- Received January 4, 2019.
- Revision received March 7, 2019.
- Accepted March 14, 2019.
- 2019 American College of Cardiology Foundation
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