Comparison between Local Abnormal Ventricular Activities (LAVA) Elimination vs. Scar-Dechanneling as two Substrate-Based Approaches for Ablation of Scar-Related Ventricular Tachycardia

Abstract

ubstrate-based approaches for ablation of scar-related ventricular tachycardia (VT) have gained wide popularity as they can help overcome the challenges of conventional mapping techniques particularly in VT storm patients. In our prospective observational study, we aimed to compare the outcomes of scar dechanneling vs. local abnormal ventricular activity (LAVA) elimination for ablation in our patient cohort. We have enrolled 30 consecutive patients (mean age 58.13 years) with scar-related VT (the majority had VT storm). We used either the scar dechanneling (in 14 patients) or the LAVA elimination (in 16 patients) method. No significant difference was found between the two groups regarding the median procedure duration, the median number of ablation points or the acute procedural success rate (87.5% and 78.5% in the LAVA and dechanneling groups respectively) with a relatively low rate of procedural complications. At 12 months follow up, the overall recurrence rate was comparable in both groups (62.5% and 50% in the LAVA and dechanneling groups respectively). Though, the rate of recurrence may be quite high, the ablation procedure has significantly impacted on the rate of recurrence of VT storm in both groups. VT non-inducibility is a sensible procedural end point but rather insufficient for accurate prediction of long-term freedom from VT recurrenc