Ab-452673-2 repeat standard ablation or intramural needle ablation after failed standard ablation for ventricular tachycardia

Some patients with recurrent scar-related VT after failed standard RF ablation (sRFA) benefit from a repeat sRFA, whereas others require advanced ablation methods such as intramural needle ablation (INA). To assess the frequency and possible clinical markers of successful repeat sRFA ablation compared to INA in patients with prior failed sRFA who were referred for INA. In consecutive pts with scar-related VT that recurred despite sRFA who were enrolled in a trial for INA, repeat sRFA was considered first. INA was performed if VT remained inducible or no sRFA targets were identified. Findings and outcomes were compared for pts treated with repeat sRFA only versus INA. We defined improvement during follow-up as a 70% decrease of VT frequency. Of 85 pts enrolled sRFA only was performed in 30 (35%) and INA was performed in 55 (65%). INA and sRFA groups were similar in heart diseases, number of prior sRFA, and VT frequency. Inducible VT was abolished or modified (acute success) in 23/85 pts (27%) with sRFA and acute success increased to 56 pts (66%) with the addition of INA when sRFA failed or targets were absent. In multivariable analysis, INA was more likely to be performed for septal VTs (Odds ratio: 5.4, 95% confidence interval: 1.9-16.6, P=0.002). Complications were similar in both groups. During follow-up improvement or abolition of VT occurred with only sRFA in 16/77 (21%) patients and increased to 42/77 (55%) with the addition of INA. In difficult to treat recurrent sustained VT that has failed standard RFA and are referred for advanced therapy, 20% have a favorable outcome with repeat standard RFA. Addition of Intramural Needle Ablation achieves a favorable outcome to over half of all patients. Septal VTs are most likely to require INA.