Impact of New Technologies and Approaches for Post–Myocardial Infarction Ventricular Tachycardia Ablation During Long-Term Follow-Up

International audienceBackground: Over the past years, many innovations have been introduced to facilitate catheter ablation of post-myocardial infarction ventricular tachycardia (post-MI VT). However, the predictors of outcome after ablation were not thoroughly studied.Methods and results: From 2009 to 2013, consecutive patients referred for post-MI VT ablation were included. The endpoint of the procedure was complete elimination of local abnormal ventricular activities (LAVA) and VT non-inducibility. The predictors of outcome with primary endpoint of VT recurrence were assessed. A total of 125 patients were included (64±11y, 7 women) for 142 procedures. The left ventricle was accessed via transseptal, retrograde-aortic and epicardial approach in 87%, 33% and 37%, respectively. 3-dimensional electroanatomical mapping system (3D-EAM) was used in 70%, multipolar catheter in 51% and real-time image integration in 38% (from MRI in 39%, MDCT in 93%). Before ablation VT was inducible in 75%, and endocardial/epicardial LAVA were present in 88%/75%. After ablation, complete LAVA elimination was achieved in 60%, and VT non-inducibility in 83%. Over a median follow-up of 850 days (IQR 439-1707), VT recurrence was observed in 36%. Multivariable analysis identified 3 independent outcome predictors: the ability to achieve complete LAVA elimination (R2=0.29, P