The Utility of Ventricular Catheter Ablation in a Large Israeli Tertiary Center

Aim

To describe the experience of a tertiary medical center in ventricular catheter ablation in Israel.

Methods

Between January 2014 to December 2017, 83 consecutive patients who underwent a total of 99 ablation procedures who were eligible for catheter ablation were prospectively enrolled and followed up. Full success was defined as non inducibility of any VT with aggressive programmed ventricular stimulation. Partial success was defined as elimination of the clinical VT but any VT could still be induced at the end of the procedure. If the clinical VT was still inducible at the conclusion of the procedure the procedure was defined as failure. Recurrence of VT during follow up was defined as any VT up to 1 year post procedure including VT that resolved with ATP.

Results

The etiology of VT was due to ischemic cardiomyopathy in 75 (76%) of the patients. A third of the ablations were due to VT storms. Mechanical circulatory support (ECMO in 13 and Impella in 1) was used in 16% of the cases. We were able to achieve full success in 60 (61%) of cases. In 16 (16%) only partial success was achieved and in 13 (13%) the procedure failed. In another 10% of cases inducibility was not checked due to hemodynamic instability of the patient during the procedure. Procedure related mortality was 2%. The recurrence rate of any VT at one year of follow up was 21%. Those patients whose ablation ended with full success were less likely to have VT recurrence than patients with partial success or failure of the ablation procedure (p<0.03).

Conclusions VT catheter ablations is an effective treatment option for very high risk patients with VTs with a relatively low mortality rate illness . It is important to try and eliminate any inducible VT to achieve long term clinical success.