Main Findings
We evaluated the VT recurrence in patients in whom VT non-inducibility
could not be achieved at the end of the RF ablation and the factors
attributed to the VT recurrence in ICM and NICM patients.
The main findings of our study were:
1. During the median follow-up period of 1.4 years (IQR, 0.3-2.0), 66%
of the patients in whom VT non-inducibility could not be achieved at the
end of RF ablation had no recurrence.
2. Patients whose LVEF was more than or equal to 35%, or in whom all
clinical VT isthmuses could successfully be identify and ablated were
independent predictors of fewer VT recurrences in the multivariate
analysis.
3. Even in patients with VT recurrences, VT ablation could significantly
reduce the VT burden.
Endpoint of the VT ablationIt is known that VT non-inducibility at the end of the VT ablation is
less likely to be associate with a VT recurrence6,7and achieving the combined endpoint of the abolition of the abnormal
electrograms and VT non-inducibility further reduces the VT
recurrence.8,9 In the present study, 20 patients in
whom VT non-inducibility was achieved had a small VT recurrence rate of
15%. However, we need to consider the risk of overtreatment at the same
time; the enlargement of a scar area by RF ablation may lead to a more
depressed cardiac function. There is not enough detailed reporting on
the subsequent events in patients with residual VT inducibility at the
end of the procedure. In our study, patients with an LVEFâ„35% or
successful identification and ablation of all clinical VT isthmuses were
independent predictors of VT non-recurrence in patients in whom VT
non-inducibility was not achieved. This may indicate that we should try
to identify the isthmus of the clinical VT as much as possible, and that
in this group of patients, inducible residual non-clinical VT is
acceptable.