Long-Term Outcome of Substrate Modification in Ablation of Post-Myocardial Infarction Ventricular Tachycardia

BACKGROUND: Long-term results of substrate modification for ablation of ventricular tachycardia (VT) have not been reported. We report long-term outcomes of substrate elimination targeting local abnormal ventricular activities (LAVA) for post-myocardial infarction VT. METHODS AND RESULTS: One hundred fifty-nine consecutive patients undergoing first ablation were included (65 +/- 11 years, 92% implantable cardioverter defibrillators, 54% storms, and 73% appropriate shocks). LAVA were identified in 92% and VT was inducible in 73%. Complete LAVA elimination and noninducibility after ablation were achieved in 64% and 85%. During a median follow-up of 47 months (interquartile range, 34-82), single-procedure ventricular arrhythmia (VA)-free survival was 55% (10% storms and 19% shocks). The VA-free survival was 73%, 68%, 61%, 55%, and 49% after 1, 2, 3, 4, and 5 years, respectively. Complete LAVA elimination was associated with improved outcomes: VA-free survival of 82% at 1 year and 61% at 5 years. In the subgroup treated with multielectrode mapping and real-time image integration, VA-free survival was 86% and 65% at 1 year and 4 years, respectively. Including repeat procedures in 18% of pts (1.3 +/- 0.6 ablations/pt) outcomes improved to 69% VA-free survival (2% storms and 9% shocks) during median 46-month follow-up. Overall survival was 91% at 1 year and 77% at 5 years of follow-up. CONCLUSIONS: In this monocentric study, substrate modification targeting LAVA for post-myocardial infarction VT resulted in a substantial reduction of VT storm and implantable cardioverter defibrillator shocks and up to 49% of patients free from arrhythmia at 5 years after a single procedure. Complete LAVA elimination, multielectrode mapping, and real-time integration were associated with improved VA-free survival.