Hemodynamic Support in Ventricular Tachycardia Ablation. An International VT Ablation Center Collaborative Group Study

Mohit K. Turagam, Venkat Vuddanda, Donita Atkins, Pasquale Santangeli, David S. Frankel, Roderick Tung, Marmar Vaseghi, William H. Sauer, Wendy Tzou, Nilesh Mathuria, Shiro Nakahara, Timm M. Dickfeld, T. Jared Bunch, Peter Weiss, Luigi Di Biase, Venkat Tholakanahalli, Kairav Vakil, Usha B. Tedrow, William G. Stevenson, Paolo Della Bella & 6 others Kalyanam Shivkumar, Francis E. Marchlinski, David J. Callans, Andrea Natale, Madhu Reddy, Dhanunjaya Lakkireddy

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objectives: To evaluate the clinical outcomes of patients receiving hemodynamic support (HS) during ventricular tacchycardia (VT) ablation. Background: There are limited real-world data evaluating its effect of HS in ablation outcomes. Methods: An analysis of 1,655 patients from the International VT Ablation Center Collaborative group was performed. A total of 105 patients received HS with percutaneous ventricular assist device. Results: Patients in the HS group had lower left ventricular ejection fraction (LVEF), higher New York Heart Association (NYHA) functional class, and more implantable cardioverter-defibrillator (ICD) shocks, VT storm, and antiarrhythmic drug use (all p < 0.05). The HS group also required significantly longer fluoroscopy, procedure, and total lesion time. Acute procedural success (71.8% vs. 73.7%; p = 0.04) was significantly lower and complications (12.5% vs. 6.5%; p = 0.03) and 1-year mortality (34.7% vs. 9.3%; p < 0.001) were significantly higher in the HS group. Multivariate Cox regression analysis demonstrated HS as an independent predictor of mortality (hazard ratio: 5.01; 95% confidence interval: 3.44 to 7.20; p < 0.001). There was no significant difference in VT recurrence between groups. In a subgroup analysis including LVEF ≤20% and NYHA functional class III to IV patients, acute procedural success (74.0% vs. 70.5%; p = 0.8), complications (15.6% vs. 7.8%; p = 0.2), VT recurrence (30.2% vs. 38.1%; p = 0.44), and 1-year mortality (40.0% vs. 28.8%; p = 0.2) were no different between the HS and no-HS groups. Conclusions: Patients requiring HS were sicker with multiple comorbidities and, as expected, had a significantly higher 1-year mortality than did those patients in the no-HS group. In patients with LVEF ≤20% and NYHA functional class III to IV, there was also no significant difference in clinical outcomes when compared with no HS. Further studies are needed to systematically evaluate patients undergoing VT ablation receiving HS.

Original languageEnglish (US)
JournalJACC: Clinical Electrophysiology
DOIs
StateAccepted/In press - Jan 1 2017

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Ventricular Tachycardia
Hemodynamics
Self-Help Groups
Stroke Volume
Mortality
Recurrence
Heart-Assist Devices
Implantable Defibrillators
Anti-Arrhythmia Agents
Fluoroscopy
Comorbidity
Shock
Regression Analysis
Confidence Intervals

Keywords

  • Catheter ablation
  • Hemodynamic support
  • Percutaneous ventricular assist device
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Hemodynamic Support in Ventricular Tachycardia Ablation. An International VT Ablation Center Collaborative Group Study. / Turagam, Mohit K.; Vuddanda, Venkat; Atkins, Donita; Santangeli, Pasquale; Frankel, David S.; Tung, Roderick; Vaseghi, Marmar; Sauer, William H.; Tzou, Wendy; Mathuria, Nilesh; Nakahara, Shiro; Dickfeld, Timm M.; Bunch, T. Jared; Weiss, Peter; Di Biase, Luigi; Tholakanahalli, Venkat; Vakil, Kairav; Tedrow, Usha B.; Stevenson, William G.; Della Bella, Paolo; Shivkumar, Kalyanam; Marchlinski, Francis E.; Callans, David J.; Natale, Andrea; Reddy, Madhu; Lakkireddy, Dhanunjaya.

In: JACC: Clinical Electrophysiology, 01.01.2017.

Research output: Contribution to journalArticle

Turagam, MK, Vuddanda, V, Atkins, D, Santangeli, P, Frankel, DS, Tung, R, Vaseghi, M, Sauer, WH, Tzou, W, Mathuria, N, Nakahara, S, Dickfeld, TM, Bunch, TJ, Weiss, P, Di Biase, L, Tholakanahalli, V, Vakil, K, Tedrow, UB, Stevenson, WG, Della Bella, P, Shivkumar, K, Marchlinski, FE, Callans, DJ, Natale, A, Reddy, M & Lakkireddy, D 2017, 'Hemodynamic Support in Ventricular Tachycardia Ablation. An International VT Ablation Center Collaborative Group Study', JACC: Clinical Electrophysiology. https://doi.org/10.1016/j.jacep.2017.07.005
Turagam, Mohit K. ; Vuddanda, Venkat ; Atkins, Donita ; Santangeli, Pasquale ; Frankel, David S. ; Tung, Roderick ; Vaseghi, Marmar ; Sauer, William H. ; Tzou, Wendy ; Mathuria, Nilesh ; Nakahara, Shiro ; Dickfeld, Timm M. ; Bunch, T. Jared ; Weiss, Peter ; Di Biase, Luigi ; Tholakanahalli, Venkat ; Vakil, Kairav ; Tedrow, Usha B. ; Stevenson, William G. ; Della Bella, Paolo ; Shivkumar, Kalyanam ; Marchlinski, Francis E. ; Callans, David J. ; Natale, Andrea ; Reddy, Madhu ; Lakkireddy, Dhanunjaya. / Hemodynamic Support in Ventricular Tachycardia Ablation. An International VT Ablation Center Collaborative Group Study. In: JACC: Clinical Electrophysiology. 2017.
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abstract = "Objectives: To evaluate the clinical outcomes of patients receiving hemodynamic support (HS) during ventricular tacchycardia (VT) ablation. Background: There are limited real-world data evaluating its effect of HS in ablation outcomes. Methods: An analysis of 1,655 patients from the International VT Ablation Center Collaborative group was performed. A total of 105 patients received HS with percutaneous ventricular assist device. Results: Patients in the HS group had lower left ventricular ejection fraction (LVEF), higher New York Heart Association (NYHA) functional class, and more implantable cardioverter-defibrillator (ICD) shocks, VT storm, and antiarrhythmic drug use (all p < 0.05). The HS group also required significantly longer fluoroscopy, procedure, and total lesion time. Acute procedural success (71.8{\%} vs. 73.7{\%}; p = 0.04) was significantly lower and complications (12.5{\%} vs. 6.5{\%}; p = 0.03) and 1-year mortality (34.7{\%} vs. 9.3{\%}; p < 0.001) were significantly higher in the HS group. Multivariate Cox regression analysis demonstrated HS as an independent predictor of mortality (hazard ratio: 5.01; 95{\%} confidence interval: 3.44 to 7.20; p < 0.001). There was no significant difference in VT recurrence between groups. In a subgroup analysis including LVEF ≤20{\%} and NYHA functional class III to IV patients, acute procedural success (74.0{\%} vs. 70.5{\%}; p = 0.8), complications (15.6{\%} vs. 7.8{\%}; p = 0.2), VT recurrence (30.2{\%} vs. 38.1{\%}; p = 0.44), and 1-year mortality (40.0{\%} vs. 28.8{\%}; p = 0.2) were no different between the HS and no-HS groups. Conclusions: Patients requiring HS were sicker with multiple comorbidities and, as expected, had a significantly higher 1-year mortality than did those patients in the no-HS group. In patients with LVEF ≤20{\%} and NYHA functional class III to IV, there was also no significant difference in clinical outcomes when compared with no HS. Further studies are needed to systematically evaluate patients undergoing VT ablation receiving HS.",
keywords = "Catheter ablation, Hemodynamic support, Percutaneous ventricular assist device, Ventricular tachycardia",
author = "Turagam, {Mohit K.} and Venkat Vuddanda and Donita Atkins and Pasquale Santangeli and Frankel, {David S.} and Roderick Tung and Marmar Vaseghi and Sauer, {William H.} and Wendy Tzou and Nilesh Mathuria and Shiro Nakahara and Dickfeld, {Timm M.} and Bunch, {T. Jared} and Peter Weiss and {Di Biase}, Luigi and Venkat Tholakanahalli and Kairav Vakil and Tedrow, {Usha B.} and Stevenson, {William G.} and {Della Bella}, Paolo and Kalyanam Shivkumar and Marchlinski, {Francis E.} and Callans, {David J.} and Andrea Natale and Madhu Reddy and Dhanunjaya Lakkireddy",
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TY - JOUR

T1 - Hemodynamic Support in Ventricular Tachycardia Ablation. An International VT Ablation Center Collaborative Group Study

AU - Turagam, Mohit K.

AU - Vuddanda, Venkat

AU - Atkins, Donita

AU - Santangeli, Pasquale

AU - Frankel, David S.

AU - Tung, Roderick

AU - Vaseghi, Marmar

AU - Sauer, William H.

AU - Tzou, Wendy

AU - Mathuria, Nilesh

AU - Nakahara, Shiro

AU - Dickfeld, Timm M.

AU - Bunch, T. Jared

AU - Weiss, Peter

AU - Di Biase, Luigi

AU - Tholakanahalli, Venkat

AU - Vakil, Kairav

AU - Tedrow, Usha B.

AU - Stevenson, William G.

AU - Della Bella, Paolo

AU - Shivkumar, Kalyanam

AU - Marchlinski, Francis E.

AU - Callans, David J.

AU - Natale, Andrea

AU - Reddy, Madhu

AU - Lakkireddy, Dhanunjaya

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Objectives: To evaluate the clinical outcomes of patients receiving hemodynamic support (HS) during ventricular tacchycardia (VT) ablation. Background: There are limited real-world data evaluating its effect of HS in ablation outcomes. Methods: An analysis of 1,655 patients from the International VT Ablation Center Collaborative group was performed. A total of 105 patients received HS with percutaneous ventricular assist device. Results: Patients in the HS group had lower left ventricular ejection fraction (LVEF), higher New York Heart Association (NYHA) functional class, and more implantable cardioverter-defibrillator (ICD) shocks, VT storm, and antiarrhythmic drug use (all p < 0.05). The HS group also required significantly longer fluoroscopy, procedure, and total lesion time. Acute procedural success (71.8% vs. 73.7%; p = 0.04) was significantly lower and complications (12.5% vs. 6.5%; p = 0.03) and 1-year mortality (34.7% vs. 9.3%; p < 0.001) were significantly higher in the HS group. Multivariate Cox regression analysis demonstrated HS as an independent predictor of mortality (hazard ratio: 5.01; 95% confidence interval: 3.44 to 7.20; p < 0.001). There was no significant difference in VT recurrence between groups. In a subgroup analysis including LVEF ≤20% and NYHA functional class III to IV patients, acute procedural success (74.0% vs. 70.5%; p = 0.8), complications (15.6% vs. 7.8%; p = 0.2), VT recurrence (30.2% vs. 38.1%; p = 0.44), and 1-year mortality (40.0% vs. 28.8%; p = 0.2) were no different between the HS and no-HS groups. Conclusions: Patients requiring HS were sicker with multiple comorbidities and, as expected, had a significantly higher 1-year mortality than did those patients in the no-HS group. In patients with LVEF ≤20% and NYHA functional class III to IV, there was also no significant difference in clinical outcomes when compared with no HS. Further studies are needed to systematically evaluate patients undergoing VT ablation receiving HS.

AB - Objectives: To evaluate the clinical outcomes of patients receiving hemodynamic support (HS) during ventricular tacchycardia (VT) ablation. Background: There are limited real-world data evaluating its effect of HS in ablation outcomes. Methods: An analysis of 1,655 patients from the International VT Ablation Center Collaborative group was performed. A total of 105 patients received HS with percutaneous ventricular assist device. Results: Patients in the HS group had lower left ventricular ejection fraction (LVEF), higher New York Heart Association (NYHA) functional class, and more implantable cardioverter-defibrillator (ICD) shocks, VT storm, and antiarrhythmic drug use (all p < 0.05). The HS group also required significantly longer fluoroscopy, procedure, and total lesion time. Acute procedural success (71.8% vs. 73.7%; p = 0.04) was significantly lower and complications (12.5% vs. 6.5%; p = 0.03) and 1-year mortality (34.7% vs. 9.3%; p < 0.001) were significantly higher in the HS group. Multivariate Cox regression analysis demonstrated HS as an independent predictor of mortality (hazard ratio: 5.01; 95% confidence interval: 3.44 to 7.20; p < 0.001). There was no significant difference in VT recurrence between groups. In a subgroup analysis including LVEF ≤20% and NYHA functional class III to IV patients, acute procedural success (74.0% vs. 70.5%; p = 0.8), complications (15.6% vs. 7.8%; p = 0.2), VT recurrence (30.2% vs. 38.1%; p = 0.44), and 1-year mortality (40.0% vs. 28.8%; p = 0.2) were no different between the HS and no-HS groups. Conclusions: Patients requiring HS were sicker with multiple comorbidities and, as expected, had a significantly higher 1-year mortality than did those patients in the no-HS group. In patients with LVEF ≤20% and NYHA functional class III to IV, there was also no significant difference in clinical outcomes when compared with no HS. Further studies are needed to systematically evaluate patients undergoing VT ablation receiving HS.

KW - Catheter ablation

KW - Hemodynamic support

KW - Percutaneous ventricular assist device

KW - Ventricular tachycardia

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DO - 10.1016/j.jacep.2017.07.005

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