Management of Recurrence of Ventricular Tachycardia after Ventricular Tachycardia Ablation

Background

Ventricular tachycardia ablation (VTA) is a complex and challenging procedure with a relatively high rate of recurrences. Whether a redo VTA ablation is beneficial is not clear.

Methods

Between January 2014 to December 2017, eighty three consecutive patients who underwent a total of 99 ablation procedures who were eligible for catheter ablation were prospectively enrolled and followed up. Partial success was defined as elimination of the clinical VT but any VT (including faster VTs than the clinical 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 including VT that resolved with ATP documented with device interrogation.

Results

During one year follow up eighteen patients (21%) had recurrence of a ventricular tachycardia. Of those, 13 patients underwent 15 redo VTA procedures. The mean age of patients requiring redo was 59±12. In 4 (27%) a redo procedure was indicated due to VT storm. A redo VTA procedure resulted in full success in 10 (67%),in partial success in 1 (7%) and failure in 3 (20%). The approach used in redo VTA was combined endocardial and epicardial approach in 6 patients (40%) versus 15 (17%) in first VT ablation (P<0.01). Mechanical circulatory support was used more frequently in redo VTA (53%) vs. (9%) in 1^st VTA (p<0.001). After redo VTA only 3 (23%) patients had VT recurrence during mean follow up time of 10±11 months.

Conclusions

Redo VTAs is effective in treating VT even after a first VTA procedure. However, in order to achieve this goal there is need for a different strategy in most cases such as including mechanical circulatory support or combining an epicardial approach.