Arrhythmia exacerbation after post-infarction ventricular tachycardia ablation: prevalence and prognostic significance.

AIMS: Catheter ablation is an effective treatment for post-infarction ventricular tachycardia (VT). However, some patients may experience a worsened arrhythmia phenotype after ablation. We aimed to determine the prevalence and prognostic impact of arrhythmia exacerbation (AE) after post-infarction VT ablation. METHODS AND RESULTS: A total of 1187 consecutive patients (93% men, median age 68 years, median ejection fraction 30%) who underwent post-infarction VT ablation at six centres were included. Arrhythmia exacerbation was defined as post-ablation VT storm or incessant VT in patients without prior similar events. During follow-up (median 717 days), 426 (36%) patients experienced VT recurrence. Events qualifying as AE occurred in 67 patients (6%). Median times to VT recurrence with and without AE were 238 [interquartile range (IQR) 35-640] days and 135 (IQR 22-521) days, respectively (P = 0.25). Almost half of the patients (46%) who experienced AE experienced it within 6 months of the index procedure. Patients with AE had had longer ablation times during the ablation procedures compared to the rest of the patients (median 42 vs. 34 min, P = 0.02). Among patients with VT recurrence, the risk of death or heart transplantation was significantly higher in patients with than without AE (hazard ratio 1.99, 95% CI 1.28-3.10; P = 0.002) after adjusting for age, gender, ejection fraction, cardiac resynchronization therapy, post-ablation non-inducibility, and post-ablation amiodarone use. CONCLUSION: Arrhythmia exacerbation after ablation of infarct-related VT is infrequent but is independently associated with an adverse long-term outcome among patients who experience a VT recurrence. The mechanisms and mitigation strategies of AE after catheter ablation require further investigation.

Initial Experience with A Novel Flexible-Tip Irrigated Ablation Catheter in a Case of Paroxysmal Atrial Fibrillation.

AF ablation can be curative or reduce the symptoms of AF. However, success rates are suboptimal while procedure times can be long. Since AF ablation depends on excellent tip to tissue contact, ease of use and signal quality, a new ablation catheter (FlexAbilityTM Ablation Catheter, St Jude Medical, St Paul, MN) was designed for use during complex ablation. We report an initial case of its use during paroxysmal AF.