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.
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