Arrhythmia exacerbation after post-infarction ventricular tachycardia ablation: prevalence and prognostic significace

Siontis, K.C.; Kim, H.M.; Vergara, P.; Peretto, G.; D.H. do; Riva, M. de; ... ; Bogun, F.M. (2020)

Article / Letter to editor

Aims Catheter ablation is an effective treatment for post-infarction ventricular tachycardia (VT). However, some patients may experience a worsened arrhythmia phenotype after ablation. We aimed to determine the prevalence and prognostic impact of arrhythmia exacerbation (AE) after post-infarction VT ablation.Methods and results A total of 1187 consecutive patients (93% men, median age 68 years, median ejection fraction 30%) who underwent post-infarction VT ablation at six centres were included. Arrhythmia exacerbation was defined as post ablation VT storm or incessant VT in patients without prior similar events. During follow-up (median 717 days), 426 (36%) patients experienced VT recurrence. Events qualifying as AE occurred in 67 patients (6%). Median times to VT recurrence with and without AE were 238 [interquartile range (IQR) 35-640] days and 135 (IQR 22-521) days, respectively (P= 0.25). Almost half of the patients (46%) who experienced AE experienced it within 6 months of the index procedure. Patients with AE had had longer ablation times during the ablation procedures compared to the rest of the patients (median 42 vs. 34 min, P = 0.02). Among patients with VT recurrence, the risk of death or heart transplantation was significantly higher in patients with than without AE (hazard ratio 1.99, 95% CI 1.28-3.10; P= 0.002) after adjusting for age, gender, ejection fraction, cardiac resynchronization therapy, post-ablation non-inducibility, and post-ablation amiodarone use.Conclusion Arrhythmia exacerbation after ablation of infarct-related VT is infrequent but is independently associated with an adverse long-term outcome among patients who experience a VT recurrence. The mechanisms and mitigation strategies of AE after catheter ablation require further investigation.

• Ventricular tachycardia
• Catheter ablation
• Recurrence
• Arrhythmia exacerbation
• Proarrhythmia

• All authors: Siontis, K.C.; Kim, H.M.; Vergara, P.; Peretto, G.; D.H. do; Riva, M. de; Lam, A.; Qian, P.; Yokokawa, M.; Jongnarangsin, K.; Latchamsetty, R.; Jais, P.; Sacher, F.; Tedrow, U.; Shivkumar, K.; Zeppenfeld, K.; Bella, P. della; Stevenson, W.G.; Morady, F.; Bogun, F.M.
• Date: 2020-11-01
• Journal: EP Europace
• Volume: 22
• Issue: 11
• Pages: 1680 - 1687
• DOI: doi:10.1093/europace/euaa169
• Link: https://academic.oup.com/europace/article/22/11/1680/5896128