Background

Ventricular arrhythmia inducibility is one of the ideal endpoints of ventricular tachycardia (VT) ablation. However, it may be challenging to implement programmed electrical stimulation (PES) at the end of the procedure under several circumstances. The long-term outcome of patients who did not undergo PES after VT ablation remains largely unknown.

Purpose

To investigate the details and long-term outcome of VT ablation in patients who did not undergo PES at the end of the ablation procedure.

Methods

Among 183 VT ablation procedures in patients with structural heart disease who underwent VT ablation using an irrigated catheter, we enrolled those who did not undergo PES after VT ablation. VT ablation strategy involved targeting clinical VT plus pacemap-guided substrate ablation if inducible. When VT was not inducible, substrate-based ablation was performed. The primary endpoint was VT recurrence.

Results

In 58 procedures, post-ablation VT inducibility was not assessed. The causes were non-inducibility of sustained VT before ablation (27/58, 46.6%), long procedure time (27.6%, mean 392 min), complications (10.3%), intolerant hemodynamic state (10.3%), and inaccessible or unsafe target (6.9%). With regard to the primary endpoint, 23 recurrences (39.7%) were observed during a mean follow-up period of 2.5 years. Patients with non-inducibility before ablation showed less VT recurrences (4/27, 14.8%) during follow-up than patients with other causes of untested PES after ablation (19/31, 61.2%) (Log-rank < 0.001).

Conclusions

VT recurrence was not observed in approximately 60% of the patients who did not undergo PES at the end of the ablation procedure. PES after VT ablation may be not needed among patients with pre-ablation non-inducibility.

中文翻译：

---

消融后未接受程序化电刺激的室性心动过速消融的长期结果

背景

室性心律失常的诱发能力是室性心动过速 (VT) 消融的理想终点之一。然而，在某些情况下，在程序结束时实施程序化电刺激 (PES) 可能具有挑战性。VT 消融后未接受 PES 的患者的长期结果在很大程度上仍然未知。

目的

调查在消融手术结束时未接受 PES 的患者 VT 消融的细节和长期结果。

方法

在使用冲洗导管接受 VT 消融的结构性心脏病患者的 183 例 VT 消融手术中，我们招募了那些在 VT 消融后未接受 PES 的患者。VT 消融策略涉及针对临床 VT 加上起搏图引导的底物消融（如果可诱导）。当 VT 不可诱导时，进行基于基质的消融。主要终点是 VT 复发。

结果

在 58 个程序中，未评估消融后 VT 的诱发能力。原因是消融前持续性 VT 的不可诱导性 (27/58, 46.6%)、手术时间长（27.6%，平均 392 分钟）、并发症 (10.3%)、不耐受的血流动力学状态 (10.3%) 以及难以接近或不安全目标 (6.9%)。关于主要终点，在平均 2.5 年的随访期内观察到 23 例 (39.7%) 复发。消融前非诱导性患者在随访期间的 VT 复发率 (4/27, 14.8%) 低于消融后其他原因导致未经测试 PES 的患者 (19/31, 61.2%)（对数秩 < 0.001）。

结论

在消融手术结束时未接受 PES 的大约 60% 的患者中未观察到 VT 复发。消融前不可诱导的患者可能不需要 VT 消融后的 PES。