Noninducibility in Postinfarction Ventricular Tachycardia as an End Point for Ventricular Tachycardia Ablation and Its Effects on Outcomes

Abstract

Background— Although ventricular tachycardia (VT) ablation is a widely used therapy for patients with VT, the ideal end points for this procedure are not well defined. We performed a meta-analysis of the published literature to assess the predictive value of noninducibility of postinfarction VT for long-term outcomes after VT ablation. Methods and Results— We performed a systematic review of MEDLINE (1950–2013), EMBASE (1988–2013), the Cochrane Controlled Trials Register (Fourth Quarter, 2012), and reports presented at scientific meetings (1994–2013). Randomized controlled trials, case–control, and cohort studies of VT ablation were included. Outcomes reported in eligible studies were freedom from VT/ventricular fibrillation and all-cause mortality. Of the 3895 studies evaluated, we identified 8 cohort studies enrolling 928 patients for the meta-analysis. Noninducibility after VT ablation was associated with a significant increase in arrhythmia-free survival compared with partial success (odds ratio, 0.49; 95% confidence interval, 0.29–0.84; P =0.009) or failed ablation procedure (odds ratio, 0.10; 95% confidence interval, 0.06–0.18; P <0.001). There was also a significant reduction in all-cause mortality if patients were noninducible after VT ablation compared with patients with partial success (odds ratio, 0.59; 95% confidence interval, 0.36–0.98; P =0.04) or failed ablation (odds ratio, 0.32; 95% confidence interval, 0.10–0.99; P =0.049). Conclusions— Noninducibility of VT after VT ablation is associated with improved arrhythmia-free survival and all-cause mortality.