TY - JOUR
T1 - Hemodynamic Support in Ventricular Tachycardia Ablation
T2 - 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
N1 - Publisher Copyright:
© 2017 American College of Cardiology Foundation
PY - 2017/12/26
Y1 - 2017/12/26
N2 - Objectives This study sought 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 This study sought 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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U2 - 10.1016/j.jacep.2017.07.005
DO - 10.1016/j.jacep.2017.07.005
M3 - Article
C2 - 29759835
AN - SCOPUS:85034431902
SN - 2405-500X
VL - 3
SP - 1534
EP - 1543
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 13
ER -