Jesús Almendral Garotte, MD

In patients with structural heart disease and an indication for catheter ablation, data derived from implantable cardioverter-defibrillator (ICD)-electrograms (EG) during ablation did not result in a significant decrease of the ventricular tachycardia (VT) recurrence rate. However, the results leaned towards a benefit of the experimental procedure and some of the secondary endpoints suggested that ICD-EG-derived information may be valuable.

Jesús Almendral Garotte, MD, and colleagues conducted a randomized trial based on their hypothesis that the data retrieved from ICD-EG during ablation in patients with structural heart disease and an indication for VT ablation leads to an accurate distinction between clinically and non-clinically induced VT and allows pace mapping. This would instigate a more focalized ablation on the VT and result in a more successful procedure, Dr. Almendral Garotte explained at the 2023 European Heart Rhythm Association (EHRA) Congress, held from April 16 to 18, in Barcelona, Spain.¹

The study included 260 patients who were randomized 1:1 to the ICD-EG arm or to the conventional ablation arm.Compared with the conventional procedure, the ICD-EG procedure was significantly linked with a clearer distinction between clinically and non-clinically induced VT, (P<0.001). Additionally, pace mapping was more applicable in the experimental arm than in the control arm (P<0.001). However, at 6 months, the primary endpoint of VT recurrence was not met: 36% in the ICD-EG arm versus 46% in the conventional arm (HR 0.73; logrank P=0.1). The number of VT relapses (P=0.0001) and the incidence of arrhythmic storms (logrank P=0.007), which were secondary endpoints, were significantly lower in the ICD-EG arm than in the conventional arm, suggesting the  experimental procedure may be beneficial.

Copyright ©2023 Medicom Medical Publishers