TY - JOUR
T1 - Impact of Number of Oral Antiarrhythmic Drug Failures Before Referral on Outcomes Following Catheter Ablation of Ventricular Tachycardia
AU - Romero, Jorge
AU - Stevenson, William G.
AU - Fujii, Akira
AU - Kapur, Sunil
AU - Baldinger, Samuel H.
AU - Mehta, Nishaki K.
AU - John, Roy M.
AU - Michaud, Gregory F.
AU - Epstein, Laurence M.
AU - Koplan, Bruce A.
AU - Tedrow, Usha B.
AU - Kumar, Saurabh
N1 - Publisher Copyright:
© 2018
PY - 2018/6
Y1 - 2018/6
N2 - 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.
AB - 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.
KW - antiarrhythmic drugs
KW - catheter ablation
KW - ischemic cardiomyopathy
KW - nonischemic cardiomyopathy
KW - ventricular tachycardia
UR - http://www.scopus.com/inward/record.url?scp=85044606169&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85044606169&partnerID=8YFLogxK
U2 - 10.1016/j.jacep.2018.01.016
DO - 10.1016/j.jacep.2018.01.016
M3 - Article
C2 - 29929675
AN - SCOPUS:85044606169
SN - 2405-500X
VL - 4
SP - 810
EP - 819
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 6
ER -