Impact of Number of Oral Antiarrhythmic Drug Failures Before Referral on Outcomes Following Catheter Ablation of Ventricular Tachycardia

Jorge E. Romero, William G. Stevenson, Akira Fujii, Sunil Kapur, Samuel H. Baldinger, Nishaki K. Mehta, Roy M. John, Gregory F. Michaud, Laurence M. Epstein, Bruce A. Koplan, Usha B. Tedrow, Saurabh Kumar

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Objectives: This study sought to examine the relationship between the number of oral antiarrhythmic drug (AAD) failures before referral for ventricular tachycardia (VT) ablation and subsequent clinical outcomes. Background: Failure of AADs prompts referral for VT ablation. Methods: Consecutive patients (n = 669) with sustained VT who were referred for a first-time ablation were divided into 2 groups according to the number of oral class 1 or 3 AAD failures before referral: single-drug failure (≤1 AAD; n = 256) or multidrug failure (>1 AADs; n = 413). Outcomes were stratified according to underlying disease type (no structural heart disease [SHD] [n = 87]; ischemic cardiomyopathy [ICM] [n = 368]; and ischemic cardiomyopathy [NICM] [n = 214]) and reported at a mean follow-up of 35 ± 46 months. Results: Patients with multidrug failure, compared with patients with single-drug failure, had more advanced SHD and required more extensive ablation to control arrhythmia. Multidrug failure, compared with single-drug failure, was associated with lower ventricular arrhythmia–free survival in ICM (46 ± 4% vs. 58 ± 6%; p = 0.03) and NICM (26 ± 5% vs. 49 ± 6%; p = 0.008), but not in the absence of SHD (71 ± 8% vs. 85 ± 7%; p = 0.10). Overall survival was lower in multidrug failure versus single-drug failure groups in patients with ICM (71 ± 3% vs. 84 ± 4%; p = 0.03) and NICM (70 ± 5% vs. 88 ± 4%; p < 0.001). Multidrug failure was independently associated with a higher risk of ventricular arrhythmia recurrence (hazard ratio: 1.6; P = 0.01) and mortality in NICM (hazard ratio: 2.6; p = 0.008), but not in ICM. Conclusions: Patients with SHD and failure of multiple oral AADs before VT ablation referral have more advanced heart disease and worse clinical outcomes following ablation, especially in NICM.

Original languageEnglish (US)
JournalJACC: Clinical Electrophysiology
DOIs
StateAccepted/In press - Jan 1 2018

Keywords

  • antiarrhythmic drugs
  • catheter ablation
  • ischemic cardiomyopathy
  • nonischemic cardiomyopathy
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Romero, J. E., Stevenson, W. G., Fujii, A., Kapur, S., Baldinger, S. H., Mehta, N. K., John, R. M., Michaud, G. F., Epstein, L. M., Koplan, B. A., Tedrow, U. B., & Kumar, S. (Accepted/In press). Impact of Number of Oral Antiarrhythmic Drug Failures Before Referral on Outcomes Following Catheter Ablation of Ventricular Tachycardia. JACC: Clinical Electrophysiology. https://doi.org/10.1016/j.jacep.2018.01.016