Can ICD Electrograms Help Ventricular Tachycardia Ablation? Results From the Multicenter Randomized AIDEG-VTA Trial
BACKGROUND The results of ablation of sustained monomorphic ventricular tachycardia (SMVT) are suboptimal. For many patients with implantable cardioverter-defibrillators (ICDs), ICD electrograms (ICD-EGs) provide the only available information on SMVT. ICD-EGs have the ability to distinguish morphol...
| Authors: | , , , , , , , , , , , , , , , , , , , |
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| Format: | article |
| Status: | Published version |
| Publication Date: | 2025 |
| Country: | España |
| Institution: | Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL) |
| Repository: | r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante |
| OAI Identifier: | oai:isabial.fundanetsuite.com:p11204 |
| Online Access: | https://isabial.portalinvestigacion.com/publicaciones11204 https://doi.org/10.1016/j.jacc.2024.10.104 |
| Access Level: | Open access |
| Keyword: | ablation electrical storm electrogram implantable cardioverter- defibrillator ventricular tachycardia |
| Summary: | BACKGROUND The results of ablation of sustained monomorphic ventricular tachycardia (SMVT) are suboptimal. For many patients with implantable cardioverter-defibrillators (ICDs), ICD electrograms (ICD-EGs) provide the only available information on SMVT. ICD-EGs have the ability to distinguish morphologically distinct SMVT and can be used for pace mapping. OBJECTIVES This study aimed to evaluate whether using ICD-EG information during an ablation procedure influences outcomes. METHODS Patients with structural heart disease and SMVT documented by an ICD-EG, undergoing ablation, were randomly assigned in a 1:1 ratio to either an ablation incorporating ICD-EG data during the procedure (intervention group) or to conventional ablation. The ICD-EG obtained during induced SMVT and pace mapping was compared to ICD-EG from spontaneous SMVT to target the "clinical" SMVT for ablation. Ablation could be performed during SMVT (if tolerated), during sinus rhythm ("substrate ablation"), or both. RESULTS A total of 15 centers randomized 260 patients. Characterization of induced SMVT as clinical/nonclinical and pace mapping were more frequent in the intervention group. Most patients underwent pure substrate ablation (65%), with complementary ablation during SMVT in 26%, showing no significant difference between groups. No differences were found in acute efficacy. In the intention-to-treat analysis, the primary endpoint of SMVT recurrence within 6 months postablation occurred in 46 (36%) patients in the intervention group and 59 (46%) in the conventional group (HR: 0.73; 95% CI: 0.49-1.07; P = 0.11). In the per-protocol analysis, SMVT recurrence at 6 months postablation reached statistical significance (HR: 0.66; 95% CI: 0.44-0.99; P = 0.045). During the entire follow-up period (44 f 29 months), SMVT recurrence occurred in 67% and 76% (HR: 0.80; 95% CI: 0.60-1.08; P = 0.14). The number of SMVT episodes was significantly lower in the intervention group (HR: 0.45; 95% CI: 0.24-0.84; P = 0.013), as was the rate of electrical storm (23% vs 41%; HR: 0.54; 95% CI: 0.34-0.85; P = 0.007). There were no differences in ICD shocks. CONCLUSIONS In patients with structural heart disease and ICD-documented SMVT, using ICD-EG information during the ablation procedure to focalize ablation toward the clinical ventricular tachycardia is associated with a nonsignificant decrease in SMVT recurrence rate, a significant reduction in the number of ventricular tachycardia episodes, and a lower rate of arrhythmic storm. (JACC. 2025;85:1124-1137) (c) 2025 by the American College of Cardiology Foundation. |
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