Effect of biventricular pacing on ventricular tachycardia recurrence after catheter ablation.

BACKGROUND

Biventricular (Bi-V) pacing improves left ventricular (LV) systolic function by correcting dyssynchrony, but potential proarrhythmic effects have been reported. The relationship between Bi-V pacing and ventricular tachycardia (VT) recurrence after catheter ablation (CA) remains unclear.

OBJECTIVE

This study aimed to assess the impact of Bi-V pacing on VT recurrence after CA in patients with structural heart disease, considering VT origin.

METHODS

Of 795 consecutive patients who underwent CA for VT, 384 met the inclusion criteria of ≥90% Bi-V pacing (Bi-V pacing group) or intrinsic atrioventricular conduction with ≤10% ventricular pacing (intrinsic rhythm group). VT origin was classified as septal, lateral, and anterior/inferior. Baseline characteristics were balanced by propensity score matching (1:1).

RESULTS

146 patients were included per group (median follow-up 473 days). All-cause mortality (26.0% vs 24.7%; log-rank P = .49) and heart failure hospitalization (21.9% vs 21.9%; log-rank P = .63) did not differ significantly between groups. VT/ventricular fibrillation recurrence was higher in the Bi-V pacing group (37.0% vs 19.2%; log-rank P < .01) than in the intrinsic rhythm group and was largely caused by greater VT recurrence in patients with lateral wall VT origins and Bi-V pacing (55.9% vs 21.9%; log-rank P < .01). In the absence of Bi-V pacing, a lateral wall VT origin was not associated with greater VT recurrences. On multivariable Cox regression, an LV lateral wall VT with Bi-V pacing was an independent predictor of VT recurrence (hazard ratio, 3.04; 95% confidence interval, 1.65-5.60; P < .01).

CONCLUSION

Bi-V pacing with an LV lateral wall substrate was associated with increased VT/ventricular fibrillation recurrence after CA.