Advantage of PREVENTIVE ablation plus implantable cardioverter-defibrillator in ischaemic cardiomyopathy

In the PREVENTIVE-VT trial, preventive ablation on top of an implantable cardioverter-defibrillator (ICD) in participants with ischaemic cardiomyopathy and infarct-related coronary chronic total occlusion was effective in reducing therapy and arrhythmia-related complications compared with an ICD alone.

The multicentre PREVENTIVE-VT trial (NCT03421834) randomised participants to either preventive ablation plus ICD or ICD alone [1]. Participants were required to have a primary ICD indication and were excluded if they were eligible for revascularisation or if they had documented ventricular arrhythmia. The aim of each ablation was the complete elimination of abnormal ventricular electrograms after high-density remapping and ventricular tachycardia non-inducibility. The primary outcome was event-driven; time to ICD implantation or ventricular arrhythmia-related hospitalisation. Included were 60 participants, with 30 assigned to each treatment strategy, with a mean follow-up of 44.7 months.

In the ICD-alone group, 13 primary outcome events were observed, while 5 events were observed in the preventive ablation group, corresponding to an HR of 0.33 (95% CI 0.12–0.94; P=0.037). Furthermore, preventive ablation led to a reduction in participants with electrical storms (0% vs 20%; P=0.01) and unplanned hospital admissions for symptomatic ventricular arrhythmia (0% vs 30%; P=0.001). Two major catheter ablation complications were reported, being a complete atrioventricular block and an ischaemic stroke.

Dr David Žižek (University Medical Centre Ljubljana, Slovenia) concluded that “preventive ablation of the infarct-related artery chronic total occlusion substrate at the time of ICD implantation is associated with a reduced risk of appropriate ICD therapy or ventricular arrhythmia-related hospitalisation.”

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   1. Žižek D, et al. Impact of preventive substrate catheter ablation on implantable cardioverter-defibrillator interventions in patients with ischaemic cardiomyopathy and infarct-related coronary chronic total occlusion. Late-Breaking Science: ablation. EHRA Congress 2024, 7–9 April, Berlin, Germany.

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Posted on 29 April 202430 April 2024