TY - JOUR
T1 - Early Mortality After Catheter Ablation of Ventricular Tachycardia in Patients With Structural Heart Disease
AU - International VT Ablation Center Collaborative Group
AU - Santangeli, Pasquale
AU - Frankel, David S.
AU - Tung, Roderick
AU - Vaseghi, Marmar
AU - Sauer, William H.
AU - Tzou, Wendy S.
AU - Mathuria, Nilesh
AU - Nakahara, Shiro
AU - Dickfeldt, Timm M.
AU - Lakkireddy, Dhanunjaya
AU - Bunch, T. Jared
AU - Di Biase, Luigi
AU - Natale, Andrea
AU - Tholakanahalli, Venkat
AU - Tedrow, Usha B.
AU - Kumar, Saurabh
AU - Stevenson, William G.
AU - Della Bella, Paolo
AU - Shivkumar, Kalyanam
AU - Marchlinski, Francis E.
AU - Callans, David J.
N1 - Publisher Copyright:
© 2017 American College of Cardiology Foundation
PY - 2017/5/2
Y1 - 2017/5/2
N2 - Background In patients referred for radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) in the setting of structural heart disease, early post-procedural mortality (EM) has not been previously investigated. Objectives The purpose of this study was to evaluate EM after catheter ablation of scar-related VT. Methods Associations between clinical and procedural variables and EM (within 31 days of the procedure) were tested in patients with structural heart disease undergoing RFCA of VT at 12 international centers. Results Of 2,061 patients (mean age 62 ± 13 years; left ventricular ejection fraction [LVEF] 34 ± 13%; 53% ischemic etiology), EM occurred in 100 (5%; 95% confidence interval [CI]: 4% to 6%). A total of 54 (3%) patients died before hospital discharge (median 9 days after the procedure; 25% for refractory VT), including 12 (0.6%) after a major procedure-related complication. In multivariable analysis, the following factors were found to be significantly associated with EM: LVEF (odds ratio [OR] per percent decrease: 1.12; 95% CI: 1.05 to 1.20; p < 0.001), chronic kidney disease (OR: 2.73; 95% CI: 1.10 to 6.80; p = 0.030), presentation with VT storm (OR: 3.61; 95% CI: 1.37 to 9.48; p = 0.009), and presence of unmappable VTs (OR: 5.69; 95% CI: 1.37 to 23.69; p = 0.017). Recurrent VT was also associated with an increased risk of subsequent death (hazard ratio: 7.19; 95% CI: 5.57 to 9.28; p < 0.001) and EM (hazard ratio: 11.45; 95% CI: 7.47 to 17.59; p < 0.001). Conclusions In a contemporary cohort of patients with scar-related VT undergoing RFCA, EM occurred in 5% of cases. Clinical and procedural variables indicating poorer clinical status (low LVEF, chronic kidney disease, VT storm, and unmappable VTs) and post-procedural VT recurrence may predict EM. Identification of such features may prompt early consideration for hemodynamic support or other care to help mitigate later potential complications.
AB - Background In patients referred for radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) in the setting of structural heart disease, early post-procedural mortality (EM) has not been previously investigated. Objectives The purpose of this study was to evaluate EM after catheter ablation of scar-related VT. Methods Associations between clinical and procedural variables and EM (within 31 days of the procedure) were tested in patients with structural heart disease undergoing RFCA of VT at 12 international centers. Results Of 2,061 patients (mean age 62 ± 13 years; left ventricular ejection fraction [LVEF] 34 ± 13%; 53% ischemic etiology), EM occurred in 100 (5%; 95% confidence interval [CI]: 4% to 6%). A total of 54 (3%) patients died before hospital discharge (median 9 days after the procedure; 25% for refractory VT), including 12 (0.6%) after a major procedure-related complication. In multivariable analysis, the following factors were found to be significantly associated with EM: LVEF (odds ratio [OR] per percent decrease: 1.12; 95% CI: 1.05 to 1.20; p < 0.001), chronic kidney disease (OR: 2.73; 95% CI: 1.10 to 6.80; p = 0.030), presentation with VT storm (OR: 3.61; 95% CI: 1.37 to 9.48; p = 0.009), and presence of unmappable VTs (OR: 5.69; 95% CI: 1.37 to 23.69; p = 0.017). Recurrent VT was also associated with an increased risk of subsequent death (hazard ratio: 7.19; 95% CI: 5.57 to 9.28; p < 0.001) and EM (hazard ratio: 11.45; 95% CI: 7.47 to 17.59; p < 0.001). Conclusions In a contemporary cohort of patients with scar-related VT undergoing RFCA, EM occurred in 5% of cases. Clinical and procedural variables indicating poorer clinical status (low LVEF, chronic kidney disease, VT storm, and unmappable VTs) and post-procedural VT recurrence may predict EM. Identification of such features may prompt early consideration for hemodynamic support or other care to help mitigate later potential complications.
KW - complications
KW - heart failure
KW - outcome assessment
KW - radiofrequency ablation
UR - http://www.scopus.com/inward/record.url?scp=85018688941&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85018688941&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2017.02.044
DO - 10.1016/j.jacc.2017.02.044
M3 - Article
C2 - 28449770
AN - SCOPUS:85018688941
SN - 0735-1097
VL - 69
SP - 2105
EP - 2115
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 17
ER -