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Acute post-procedural inducibility is a poor predictor of clinical outcomes in high-risk patients (PAINESD > 17) undergoing scar-related ventricular tachycardia ablation.
Sipko, Joseph; Baranowski, Bryan; Bhargava, Mandeep; Callahan, Thomas D; Dresing, Thomas J; Higuchi, Koji; Hussein, Ayman A; Kanj, Mohamed; Lee, Justin; Martin, David O; Nakhla, Shady; Rickard, John J; Saliba, Walid I; Taigen, Tyler; Wazni, Oussama M; Santangeli, Pasquale; Sroubek, Jakub.
Afiliación
  • Sipko J; Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
  • Baranowski B; Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
  • Bhargava M; Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
  • Callahan TD; Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
  • Dresing TJ; Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
  • Higuchi K; Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
  • Hussein AA; Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
  • Kanj M; Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
  • Lee J; Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
  • Martin DO; Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
  • Nakhla S; Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
  • Rickard JJ; Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
  • Saliba WI; Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
  • Taigen T; Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
  • Wazni OM; Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
  • Santangeli P; Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
  • Sroubek J; Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
Europace ; 26(7)2024 Jul 02.
Article en En | MEDLINE | ID: mdl-39031021
ABSTRACT

AIMS:

Ventricular tachycardia (VT) non-inducibility in response to programmed ventricular stimulation (PVS) is a widely used procedural endpoint for VT ablation despite inconclusive evidence with respect to clinical outcomes in high-risk patients. The aim is to determine the utility of acute post-ablation VT inducibility as a predictor of VT recurrence, mortality, or mortality equivalent in high-risk patients. METHODS AND

RESULTS:

We conducted a retrospective analysis of high-risk patients (defined as PAINESD > 17) who underwent scar-related VT ablation at our institution between July 2010 and July 2022. Patients' response to PVS (post-procedure) was categorized into three groups Group A, no clinical VT or VT with cycle length > 240 ms inducible; Group B, only non-clinical VT with cycle length > 240 ms induced; and Group C, all other outcomes (including cases where no PVS was performed). The combined primary endpoint included death, durable left ventricular assist device placement, and cardiac transplant (Cox analysis). Ventricular tachycardia recurrence was considered a secondary endpoint (competing risk analysis). Of the 1677 VT ablation cases, 123 cases met the inclusion criteria for analysis. During a 19-month median follow-up time (interquartile range 4-43 months), 82 (66.7%) patients experienced the composite primary endpoint. There was no difference between Groups A and C with respect to the primary [hazard ratio (HR) = 1.21 (0.94-1.57), P = 0.145] or secondary [HR = 1.18 (0.91-1.54), P = 0.210] outcomes. These findings persisted after multivariate adjustments. The size of Group B (n = 13) did not permit meaningful statistical analysis.

CONCLUSION:

The results of post-ablation PVS do not significantly correlate with long-term outcomes in high-risk (PAINESD > 17) VT ablation patients.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Recurrencia / Cicatriz / Taquicardia Ventricular / Ablación por Catéter Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Europace Asunto de la revista: CARDIOLOGIA / FISIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Recurrencia / Cicatriz / Taquicardia Ventricular / Ablación por Catéter Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Europace Asunto de la revista: CARDIOLOGIA / FISIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido