Can ICD-EG-derived information improve ventricular tachycardia ablation outcomes?

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

Prof. Jesus Almendral (HM University Hospital, Spain) and co-investigators conducted a randomised trial (NCT02274168) that hypothesised that the information 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 [1]. This would instigate a more focalised ablation on the VT and result in a more successful procedure. The 260 included patients were randomised 1:1 to the ICD-EG arm or the conventional ablation arm.

The ICD-EG procedure was significantly associated with a clearer distinction between clinically and non-clinically induced VT compared with the conventional procedure (P<0.001). Also, pace mapping was more applicable in the experimental arm than in the control arm (P<0.001). However, the primary endpoint of VT recurrence at 6 months was not met: 36% in the ICD-EG arm versus 46% in the conventional arm (HR 0.73; P_log-rank=0.1). The number of VT recurrences (P=0.0001) and the occurrence of arrhythmic storms (P_log-rank=0.007), which were secondary endpoints of the study, were significantly lower in the ICD-EG arm than in the conventional arm, suggesting there might be a benefit from the experimental procedure.

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   1. Almendral J, et al. Aid of recording ICD electrograms during monomorphic ventricular tachycardia ablation procedures. Late-Breaking Science Day 2, EHRA 2023, 16–18 April, Barcelona, Spain.

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Posted on 3 May, 202315 February, 2024