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

Abstract

Background: Substrate-based approaches for ablation of scar-related ventricular tachycardia (VT) can help
overcome the challenges of conventional mapping techniques particularly in VT storm patients.
Objective: We aimed to compare the outcomes of scar dechanneling vs. local abnormal ventricular activity (LAVA)
elimination for ablation in our patient cohort who were predominantly presenting with VT storm.
Methods and Results:
In our prospective observational study, we have enrolled 30 consecutive patients (mean age 58.13 years) with scarrelated VT (90% 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 (192 vs 157 minutes in the LAVA and dechanneling groups respectively, p value 0.142), the median
number of ablation points (74 points in each group, p value 0.93) or the acute procedural success rate (87.5% and
78.5% in the LAVA and dechanneling groups respectively, p value 0.642). 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,
p value 0.491). VT storm recurrence was 12.5% in the LAVA group compared to 35.5% in the dechanneling group
(p value 0.404), a relatively good figure considering that at baseline 90% of patients had VT storm.
Conclusion:
LAVA elimination and scar dechanneling are two comparable methods regarding efficacy and safety in ablation of
scar-related VT. Both have been associated with high acute success rates in VT storm patients.