Clinical outcomes after ventricular tachycardia ablation with or without induction

Background

Substrate mapping may offer a safer alternative to ventricular tachycardia (VT) mapping by avoiding prolonged episodes of VT during catheter ablation. However, VT induction to gauge procedural efficacy is still routinely attempted following substrate ablation, thereby exposing patients to potentially unnecessary hemodynamic risk.

Objective

The purpose of this study was to assess the efficacy of VT ablation without VT induction.

Methods

Patients with implantable cardioverter-defibrillators who underwent VT ablation between August 2020 and May 2023 were assessed retrospectively. Ablation and induction strategies were determined by operator discretion. Patients with or without attempted VT induction were compared with respect to baseline characteristics and clinical outcomes using Cox and competing risks regression.

Results

Eighty-nine patients (median age 68 years; 89% male; 51% infarct-related cardiomyopathy, mean left ventricular ejection fraction 38%) were followed for a median of 16 months after VT ablation. VT induction was attempted in 63% of patients. The 1-year incidence of recurrent VT was 37% and 58% in the noninduction and induction groups, respectively (subhazard ratio 0.55, 95% confidence interval [CI] 0.27–1.09, P = .09). The 1-year incidence of recurrent VT, heart transplant, or death was 42% and 62% in the noninduction and induction groups, respectively (hazard ratio 0.58, 95% CI 0.31–1.11, P = .10).

Conclusion

In a single-center study of 89 VT ablations, a noninduction strategy was similar to an induction strategy with respect to VT recurrence, heart transplant, or death at 1 year. Our findings suggest that VT induction, recognized as a risk factor for hemodynamic compromise, can be avoided in some patients without sacrificing procedural efficacy.