Letter from the Editor in Chief
DOI: 10.19102/icrm.2022.130308
MOUSSA MANSOUR, MD, FHRS, FACC
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Dr. Mansour reports the reception of research grants from Abbott Laboratories, Biosense Webster, Johnson & Johnson, Boston Scientific, Medtronic, Pfizer, Boehringer Ingelheim, and SentreHeart. He is also a consultant for Abbott Laboratories, Biosense Webster, Johnson & Johnson, Boston Scientific, Janssen, Medtronic, Phillips, Novartis, and SentreHeart and reports an equity relationship with EPS Solutions. All aforementioned relationships are in the area of atrial fibrillation; Dr. Mansour additionally reports an equity relationship in the area of ventricular fibrillation with NewPace Ltd.
Dear readers,
This issue of The Journal of Innovations in Cardiac Rhythm Management contains an important article by Mehta et al. titled “Utility of Ischemia Testing Prior to Ablation for Sustained Monomorphic Ventricular Tachycardia.” In this retrospective study, the authors compared clinical outcomes between patients who underwent ischemia workup and revascularization prior to ablation for monomorphic ventricular tachycardia (VT) and those who did not.1 They found that an ischemia workup, although frequently completed, infrequently led to revascularization and did not have a clinical benefit.
Although this study is retrospective and included only a small number of patients, it is important because it highlights a common and clinically relevant topic. Although monomorphic VT has been well established as a result of pre-existing scar, ischemia evaluation continues to be performed in a large number of cases prior to VT ablation. There are a few possible reasons for this practice, and some are discussed in the abovementioned article. Some prior reports and studies reported a reduction or elimination of VT after revascularization. Another reason could be a concern for hemodynamic instability during ablation in the presence of flow-limiting coronary artery disease. However, it is rare that such practice results in revascularization and improvement of the clinical outcome. A pre-ablation ischemia workup also carries some disadvantages, perhaps the most significant of which is a delay in the procedure.
This study is hypothesis-generating and hopefully will lead to a prospective clinical trial. Until then, I believe that it might impact clinical practice and would lead some clinicians, including myself, to pause a bit before performing an ischemia workup prior to ablation and instead perhaps adopt an individualized approach where such testing is performing only in situations of a clear threat of hemodynamic instability during the procedure secondary to ischemia.
I hope that you enjoy reading this issue of The Journal of Innovations in Cardiac Rhythm Management.
Sincerely,
Moussa Mansour, MD, FHRS, FACC
Editor in Chief
The Journal of Innovations in Cardiac Rhythm Management
Director, Atrial Fibrillation Program
Jeremy Ruskin and Dan Starks Endowed Chair in Cardiology
Massachusetts General Hospital
Boston, MA 02114
Reference
- Mehta NK, Schumann C, Davogustto G, et al. Utility of ischemia testing prior to ablation for sustained monomorphic ventricular tachycardia. J Innov Cardiac Rhythm Manage. 2022;13(3):4908–4914. [CrossRef]
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