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Influence of baseline inducibility and activation mapping on ablation outcomes in patients with structural heart disease and ventricular tachycardia
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  • Oscar Cano,
  • Víctor Pérez-Roselló,
  • Hebert Ayala,
  • Maite Izquierdo de Francisco,
  • Joaquín Osca,
  • Mª José Sancho-Tello,
  • Luis Martínez-Dolz
Oscar Cano
Hospital Politécnico y Universitario La Fe
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Víctor Pérez-Roselló
Hospital Politécnico y Universitario La Fe
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Hebert Ayala
Hospital Politécnico y Universitario La Fe
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Maite Izquierdo de Francisco
Hospital Politécnico y Universitario La Fe
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Joaquín Osca
Hospital Politécnico y Universitario La Fe
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Mª José Sancho-Tello
Hospital Politécnico y Universitario La Fe
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Luis Martínez-Dolz
Hospital Politécnico y Universitario La Fe
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Abstract

Introduction:Stand-alone substrate ablation without baseline ventricular tachycardia (VT) induction and activation mapping has become a standard VT ablation strategy. We sought to evaluate the influence of baseline VT inducibility and activation mapping on ablation outcomes in patients with structural heart disease (SHD) undergoing VT ablation. Methods:This is a single center, observational and retrospective study including consecutive patients with SHD and documented VT undergoing ablation. Baseline VT induction was attempted before ablation in all patients and VT activation mapping performed when possible. Ablation was guided by activation mapping for mappable VTs plus substrate ablation for all patients. Ablation outcomes and complications were evaluated. Results: 160 patients were included (203 VT ablation procedures) and were classified in 3 groups according to baseline VT inducibility: group 1 (non inducible, n=18), group 2 (1 VT morphology induced, n=53), and group 3 (>1VT morphology induced, n=89). VT activation mapping was possible in 35%. After a median follow-up of 38.5 months, baseline inducibility of >1VT morphology was associated with a significant incidence of VT recurrence (42% for group 3 vs. 15.1% for group 2 and 5.6% for group 1, Log-rank p<0.0001) and activation mapping with a lower rate of VT recurrence (24% vs. 36.3%, Log-rank p=0.035). Independent predictors of VT recurrences and mortality were baseline inducibility of >1VT morphology (HR 12.05 IC 95% 1.60-90.79, p=0.016) and LVEF<30% (HR 2.43 IC 95% 1.45-4.07, p=0.001), respectively. Complications occurred in 11.2% (5.6% hemodynamic decompensation). Conclusions:Baseline VT inducibility and activation mapping may add significant prognostic information during VT ablation procedur

Peer review status:ACCEPTED

10 Feb 2021Submitted to Journal of Cardiovascular Electrophysiology
11 Feb 2021Submission Checks Completed
11 Feb 2021Assigned to Editor
15 Feb 2021Reviewer(s) Assigned
02 Mar 2021Review(s) Completed, Editorial Evaluation Pending
08 Mar 2021Editorial Decision: Revise Minor
11 Mar 20211st Revision Received
17 Mar 2021Submission Checks Completed
17 Mar 2021Assigned to Editor
17 Mar 2021Reviewer(s) Assigned
27 Mar 2021Review(s) Completed, Editorial Evaluation Pending
28 Mar 2021Editorial Decision: Accept