Summary of main studies reporting outcome of an activation approach and a substrate-based ventricular tachycardia ablation procedure
| Study . | Design . | Patients . | Haemodynamic support . | Aetiologies . | Duration of follow-up . | Short-term outcome . | Long-term outcome . |
|---|---|---|---|---|---|---|---|
| Volkmer 2006 | Retrospective | Stable VTs were mapped during VT (n. 16) and unstable VTs during SR (n. 14). | None | Post-MI cardiomyopathy | Mean of 25 ± 13 months | In the stable VT group, acute success rate was 91% and in the substrate group was 86% after up to two procedures. | There was no difference between the outcome of VT-mapping group and the substrate-mapping group. |
| Bunch 2012 | Retrospective | Patients with haemodynamically unstable VT (13 undergoing HMS-assisted VT ablation and 18 a substrate-based procedure). | TandemHeart | Structural heart disease (LVEF ≤ 40% or arrhythmogenic right ventricular cardiomyopathy) | Mean of 9 ± 3 months | No difference in inducibility between groups (10 of 13 vs. 12 of 18; 77 vs. 67%). There was no difference in acute complications including stroke or death. | Freedom from ICD-therapies for sustained VT were similar (P = 0.96). |
| Di Biase 2012 | Prospective | Patients with ES limited substrate ablation (n. 49) or endo-epicardial ablation of abnormal potentials within the scar (n. 43). | None | Ischaemic cardiomyopathy | Mean of 25 ± 10 months | All patients in both groups were free from inducible or spontaneous VT at the end of the procedure. No periprocedural complication occurred. | VT recurrence rate was 47% in conventional group and 19% in homogenization of the scar group (log-rank P = 0.006). |
| DI Biase 2015 | Randomized | Subjects with haemodynamically tolerated VT to clinical ablation (n. 60) vs. extensive substrate-based ablation (n. 58). | None | Post-MI cardiomyopathy | 12 months | Non-inducibility of the clinical VTs was achieved in all patients in both groups. | Substrate-based ablation was associated with significantly lower VT recurrence rates than clinical ablation (15.5% vs. 48.3%; log-rank P < 0.001). Overall mortality 8.6% in the substrate-based ablation group and 15.0%) in the clinical ablation group (log-rank P = 0.21). |
| Makimoto 2015 | Retrospective | Activation mapping (n. 35) vs. substrate-based strategy was adopted (n. 50) because of non-inducibility of VT or haemodynamic instability. | None | Arrhythmogenic right ventricular cardiomyopathy (n. 34), ischaemic heart disease (16), dilated cardiomyopathy (14), sarcoidosis (11), others (10) | Mean of 61 ± 40 months | No significant difference in the success of the procedure (63% in the activation mapping group and 74% in the substrate group, P = 0.27). | No significant differences in sustained VT recurrences (15/50 vs. 15/35, P = 0.22), and cardiac death (2/50 vs. 3/35, P = 0.38). |
| Ventura 2015 | Retrospective | Stable VTs were mapped during VT (n. 16) and unstable VTs during SR (n. 14). | None | Post-MI cardiomyopathy | Mean of 14 ± 6 months | Acute success was comparable being 69% in the stable VT group and 64% in the unstable VT group (P = 0.42). | VT recurrences were comparable being 25% in the stable VT group and 43% in the unstable VT group (P = 0.82). |
| Study . | Design . | Patients . | Haemodynamic support . | Aetiologies . | Duration of follow-up . | Short-term outcome . | Long-term outcome . |
|---|---|---|---|---|---|---|---|
| Volkmer 2006 | Retrospective | Stable VTs were mapped during VT (n. 16) and unstable VTs during SR (n. 14). | None | Post-MI cardiomyopathy | Mean of 25 ± 13 months | In the stable VT group, acute success rate was 91% and in the substrate group was 86% after up to two procedures. | There was no difference between the outcome of VT-mapping group and the substrate-mapping group. |
| Bunch 2012 | Retrospective | Patients with haemodynamically unstable VT (13 undergoing HMS-assisted VT ablation and 18 a substrate-based procedure). | TandemHeart | Structural heart disease (LVEF ≤ 40% or arrhythmogenic right ventricular cardiomyopathy) | Mean of 9 ± 3 months | No difference in inducibility between groups (10 of 13 vs. 12 of 18; 77 vs. 67%). There was no difference in acute complications including stroke or death. | Freedom from ICD-therapies for sustained VT were similar (P = 0.96). |
| Di Biase 2012 | Prospective | Patients with ES limited substrate ablation (n. 49) or endo-epicardial ablation of abnormal potentials within the scar (n. 43). | None | Ischaemic cardiomyopathy | Mean of 25 ± 10 months | All patients in both groups were free from inducible or spontaneous VT at the end of the procedure. No periprocedural complication occurred. | VT recurrence rate was 47% in conventional group and 19% in homogenization of the scar group (log-rank P = 0.006). |
| DI Biase 2015 | Randomized | Subjects with haemodynamically tolerated VT to clinical ablation (n. 60) vs. extensive substrate-based ablation (n. 58). | None | Post-MI cardiomyopathy | 12 months | Non-inducibility of the clinical VTs was achieved in all patients in both groups. | Substrate-based ablation was associated with significantly lower VT recurrence rates than clinical ablation (15.5% vs. 48.3%; log-rank P < 0.001). Overall mortality 8.6% in the substrate-based ablation group and 15.0%) in the clinical ablation group (log-rank P = 0.21). |
| Makimoto 2015 | Retrospective | Activation mapping (n. 35) vs. substrate-based strategy was adopted (n. 50) because of non-inducibility of VT or haemodynamic instability. | None | Arrhythmogenic right ventricular cardiomyopathy (n. 34), ischaemic heart disease (16), dilated cardiomyopathy (14), sarcoidosis (11), others (10) | Mean of 61 ± 40 months | No significant difference in the success of the procedure (63% in the activation mapping group and 74% in the substrate group, P = 0.27). | No significant differences in sustained VT recurrences (15/50 vs. 15/35, P = 0.22), and cardiac death (2/50 vs. 3/35, P = 0.38). |
| Ventura 2015 | Retrospective | Stable VTs were mapped during VT (n. 16) and unstable VTs during SR (n. 14). | None | Post-MI cardiomyopathy | Mean of 14 ± 6 months | Acute success was comparable being 69% in the stable VT group and 64% in the unstable VT group (P = 0.42). | VT recurrences were comparable being 25% in the stable VT group and 43% in the unstable VT group (P = 0.82). |
ES, electrical storm; HMS, haemodynamic mechanical support; ICD, implantable cardioverter-defibrillator; LVEF, left ventricular ejection fraction; MI, myocardial infarction; SR, sinus rhythm; VT, ventricular tachycardia.
Summary of main studies reporting outcome of an activation approach and a substrate-based ventricular tachycardia ablation procedure
| Study . | Design . | Patients . | Haemodynamic support . | Aetiologies . | Duration of follow-up . | Short-term outcome . | Long-term outcome . |
|---|---|---|---|---|---|---|---|
| Volkmer 2006 | Retrospective | Stable VTs were mapped during VT (n. 16) and unstable VTs during SR (n. 14). | None | Post-MI cardiomyopathy | Mean of 25 ± 13 months | In the stable VT group, acute success rate was 91% and in the substrate group was 86% after up to two procedures. | There was no difference between the outcome of VT-mapping group and the substrate-mapping group. |
| Bunch 2012 | Retrospective | Patients with haemodynamically unstable VT (13 undergoing HMS-assisted VT ablation and 18 a substrate-based procedure). | TandemHeart | Structural heart disease (LVEF ≤ 40% or arrhythmogenic right ventricular cardiomyopathy) | Mean of 9 ± 3 months | No difference in inducibility between groups (10 of 13 vs. 12 of 18; 77 vs. 67%). There was no difference in acute complications including stroke or death. | Freedom from ICD-therapies for sustained VT were similar (P = 0.96). |
| Di Biase 2012 | Prospective | Patients with ES limited substrate ablation (n. 49) or endo-epicardial ablation of abnormal potentials within the scar (n. 43). | None | Ischaemic cardiomyopathy | Mean of 25 ± 10 months | All patients in both groups were free from inducible or spontaneous VT at the end of the procedure. No periprocedural complication occurred. | VT recurrence rate was 47% in conventional group and 19% in homogenization of the scar group (log-rank P = 0.006). |
| DI Biase 2015 | Randomized | Subjects with haemodynamically tolerated VT to clinical ablation (n. 60) vs. extensive substrate-based ablation (n. 58). | None | Post-MI cardiomyopathy | 12 months | Non-inducibility of the clinical VTs was achieved in all patients in both groups. | Substrate-based ablation was associated with significantly lower VT recurrence rates than clinical ablation (15.5% vs. 48.3%; log-rank P < 0.001). Overall mortality 8.6% in the substrate-based ablation group and 15.0%) in the clinical ablation group (log-rank P = 0.21). |
| Makimoto 2015 | Retrospective | Activation mapping (n. 35) vs. substrate-based strategy was adopted (n. 50) because of non-inducibility of VT or haemodynamic instability. | None | Arrhythmogenic right ventricular cardiomyopathy (n. 34), ischaemic heart disease (16), dilated cardiomyopathy (14), sarcoidosis (11), others (10) | Mean of 61 ± 40 months | No significant difference in the success of the procedure (63% in the activation mapping group and 74% in the substrate group, P = 0.27). | No significant differences in sustained VT recurrences (15/50 vs. 15/35, P = 0.22), and cardiac death (2/50 vs. 3/35, P = 0.38). |
| Ventura 2015 | Retrospective | Stable VTs were mapped during VT (n. 16) and unstable VTs during SR (n. 14). | None | Post-MI cardiomyopathy | Mean of 14 ± 6 months | Acute success was comparable being 69% in the stable VT group and 64% in the unstable VT group (P = 0.42). | VT recurrences were comparable being 25% in the stable VT group and 43% in the unstable VT group (P = 0.82). |
| Study . | Design . | Patients . | Haemodynamic support . | Aetiologies . | Duration of follow-up . | Short-term outcome . | Long-term outcome . |
|---|---|---|---|---|---|---|---|
| Volkmer 2006 | Retrospective | Stable VTs were mapped during VT (n. 16) and unstable VTs during SR (n. 14). | None | Post-MI cardiomyopathy | Mean of 25 ± 13 months | In the stable VT group, acute success rate was 91% and in the substrate group was 86% after up to two procedures. | There was no difference between the outcome of VT-mapping group and the substrate-mapping group. |
| Bunch 2012 | Retrospective | Patients with haemodynamically unstable VT (13 undergoing HMS-assisted VT ablation and 18 a substrate-based procedure). | TandemHeart | Structural heart disease (LVEF ≤ 40% or arrhythmogenic right ventricular cardiomyopathy) | Mean of 9 ± 3 months | No difference in inducibility between groups (10 of 13 vs. 12 of 18; 77 vs. 67%). There was no difference in acute complications including stroke or death. | Freedom from ICD-therapies for sustained VT were similar (P = 0.96). |
| Di Biase 2012 | Prospective | Patients with ES limited substrate ablation (n. 49) or endo-epicardial ablation of abnormal potentials within the scar (n. 43). | None | Ischaemic cardiomyopathy | Mean of 25 ± 10 months | All patients in both groups were free from inducible or spontaneous VT at the end of the procedure. No periprocedural complication occurred. | VT recurrence rate was 47% in conventional group and 19% in homogenization of the scar group (log-rank P = 0.006). |
| DI Biase 2015 | Randomized | Subjects with haemodynamically tolerated VT to clinical ablation (n. 60) vs. extensive substrate-based ablation (n. 58). | None | Post-MI cardiomyopathy | 12 months | Non-inducibility of the clinical VTs was achieved in all patients in both groups. | Substrate-based ablation was associated with significantly lower VT recurrence rates than clinical ablation (15.5% vs. 48.3%; log-rank P < 0.001). Overall mortality 8.6% in the substrate-based ablation group and 15.0%) in the clinical ablation group (log-rank P = 0.21). |
| Makimoto 2015 | Retrospective | Activation mapping (n. 35) vs. substrate-based strategy was adopted (n. 50) because of non-inducibility of VT or haemodynamic instability. | None | Arrhythmogenic right ventricular cardiomyopathy (n. 34), ischaemic heart disease (16), dilated cardiomyopathy (14), sarcoidosis (11), others (10) | Mean of 61 ± 40 months | No significant difference in the success of the procedure (63% in the activation mapping group and 74% in the substrate group, P = 0.27). | No significant differences in sustained VT recurrences (15/50 vs. 15/35, P = 0.22), and cardiac death (2/50 vs. 3/35, P = 0.38). |
| Ventura 2015 | Retrospective | Stable VTs were mapped during VT (n. 16) and unstable VTs during SR (n. 14). | None | Post-MI cardiomyopathy | Mean of 14 ± 6 months | Acute success was comparable being 69% in the stable VT group and 64% in the unstable VT group (P = 0.42). | VT recurrences were comparable being 25% in the stable VT group and 43% in the unstable VT group (P = 0.82). |
ES, electrical storm; HMS, haemodynamic mechanical support; ICD, implantable cardioverter-defibrillator; LVEF, left ventricular ejection fraction; MI, myocardial infarction; SR, sinus rhythm; VT, ventricular tachycardia.
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