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Late Potential Abolition in Ventricular Tachycardia Ablation

  • Ivo Roca-Luque
    Correspondence
    Corresponding author: Tel. + 34932275551; fax: +34934513045.
    Affiliations
    Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain

    Biomedical Investigation Institute August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain

    Biomedical Investigation Center and Cardiovascular Diseases Net (CIBERCV), Madrid, Spain
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  • Levio Quinto
    Affiliations
    Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain

    Biomedical Investigation Institute August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
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  • Paula Sanchez-Somonte
    Affiliations
    Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain

    Biomedical Investigation Institute August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
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  • Paz Garre
    Affiliations
    Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain

    Biomedical Investigation Institute August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
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  • Francisco Alarcón
    Affiliations
    Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain

    Biomedical Investigation Institute August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain

    Biomedical Investigation Center and Cardiovascular Diseases Net (CIBERCV), Madrid, Spain
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  • Fatima Zaraket
    Affiliations
    Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain

    Biomedical Investigation Institute August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
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  • Sara Vazquez
    Affiliations
    Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain

    Biomedical Investigation Institute August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
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  • Susana Prat-Gonzalez
    Affiliations
    Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain

    Biomedical Investigation Institute August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
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  • Jose T. Ortiz-Perez
    Affiliations
    Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain

    Biomedical Investigation Institute August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
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  • Eduard Guasch
    Affiliations
    Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain

    Biomedical Investigation Institute August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain

    Biomedical Investigation Center and Cardiovascular Diseases Net (CIBERCV), Madrid, Spain
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  • José Maria Tolosana
    Affiliations
    Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain

    Biomedical Investigation Institute August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain

    Biomedical Investigation Center and Cardiovascular Diseases Net (CIBERCV), Madrid, Spain
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  • Elena Arbelo
    Affiliations
    Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain

    Biomedical Investigation Institute August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain

    Biomedical Investigation Center and Cardiovascular Diseases Net (CIBERCV), Madrid, Spain
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  • Antonio Berruezo
    Affiliations
    Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain

    Biomedical Investigation Institute August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
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  • Marta Sitges
    Affiliations
    Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain

    Biomedical Investigation Institute August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain

    Biomedical Investigation Center and Cardiovascular Diseases Net (CIBERCV), Madrid, Spain
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  • Josep Brugada
    Affiliations
    Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain

    Biomedical Investigation Institute August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain

    Biomedical Investigation Center and Cardiovascular Diseases Net (CIBERCV), Madrid, Spain
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  • Lluís Mont
    Affiliations
    Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain

    Biomedical Investigation Institute August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain

    Biomedical Investigation Center and Cardiovascular Diseases Net (CIBERCV), Madrid, Spain
    Search for articles by this author
      Ventricular tachycardia (VT) substrate-based ablation has become the gold standard treatment for patients with structural heart disease–related VT. VT is linked to re-entry in relation to myocardial scarring, with areas of conduction block (core scar) and of slow conduction (border zone). Slow conduction areas can be detected in sinus rhythm as late potentials (LPs). LP abolition has been shown to be the best end point to avoid long-term recurrences. Our study aimed to analyze the challenges of LP abolition and the predictors of failure. We analyzed 169 consecutive patients with structural heart disease (61% ischemic cardiomyopathy, left ventricular ejection fraction: 37 ± 13%) who underwent VT ablation between 2013 and 2018. A preprocedural clinical evaluation, including cardiac magnetic resonance, was done in 66% of patients. Electroanatomical mapping with the identification of LPs was performed in all patients. Noninducibility was achieved in 71% (119), and complete LP abolition was achieved in 61% (103) of patients. Incomplete LP abolition was a powerful predictor of VT recurrence (67% vs 33%, hazard ratio 3.19 [2.1 to 4.7]; p <0.001). Lack of use of a high-density mapping catheter (odds ratio 6.2, 1.2 to 38.1; p = 0.028), the septal substrate (odds ratio 9.34, 2.27 to 38.4; p = 0.002), and larger left ventricular mass (190 ± 58 g vs 156 ± 46 g, p = 0.002) were predictors of incomplete LP abolition. The main reasons that contributed to unsuccessful LP abolition were anatomic obstacles (such as the conduction system) and large extension of the LP area. In conclusion, incomplete LP abolition is related to VT recurrence. Lack of use of a high-density mapping catheter, the septal substrate, and larger left ventricular mass are related to incomplete LP abolition.
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