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.