TY - JOUR
T1 - Long-term outcomes after catheter ablation of ventricular tachycardia in patients with and without structural heart disease
AU - Kumar, Saurabh
AU - Romero, Jorge
AU - Mehta, Nishaki K.
AU - Fujii, Akira
AU - Kapur, Sunil
AU - Baldinger, Samuel H.
AU - Barbhaiya, Chirag R.
AU - Koplan, Bruce A.
AU - John, Roy M.
AU - Epstein, Laurence M.
AU - Michaud, Gregory F.
AU - Tedrow, Usha B.
AU - Stevenson, William G.
N1 - Funding Information:
Dr Kumar is a recipient of the Neil Hamilton Fairley Overseas Research scholarship cofunded by the National Health and Medical Research Council and the National Heart Foundation of Australia and the Bushell Travelling Fellowship funded by the Royal Australasian College of Physicians. Dr Michaud receives consulting fees/honoraria from Boston Scientific, Medtronic, and St. Jude Medical and research funding from Boston Scientific and Biosense Webster. Dr Stevenson is coholder of a patent for needle ablation that is consigned to Brigham and Women’s Hospital. Dr Tedrow receives consulting fees/honoraria from Boston Scientific and St. Jude Medical and research funding from Biosense Webster and St. Jude Medical.
Publisher Copyright:
© 2016 Heart Rhythm Society
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Background Long-term outcomes after ventricular tachycardia (VT) ablation are sparsely described. Objectives The purpose of this study was to describe long-term prognosis after VT ablation in patients with no structural heart disease (no SHD), ischemic cardiomyopathy (ICM), and nonischemic cardiomyopathy (NICM). Methods Consecutive patients (N = 695: no SHD, 98; ICM, 358; NICM, 239) ablated for sustained VT were followed for a median of 6 years. Acute procedural parameters (complete success [noninducibility of any VT]) and outcomes after multiple procedures were reported. Results Compared with patients with no SHD or NICM, patients with ICM were the oldest, were more likely to be men, lowest left ventricular ejection fraction, highest drug failures, VT storms, and number of inducible VTs. Complete procedure success was highest in patients with no SHD than in patients with ICM and those with NICM (79%, 56%, 60%, respectively; P < .001). At 6 years, ventricular arrhythmia (VA)–free survival was highest in patients with no SHD (77%) than in patients with ICM (54%) and those with NICM (38%) (P < .001), and overall survival was lowest in patients with ICM (48%), followed by patients with NICM (74%) and patients with no SHD (100%) (P < .001). Age, left ventricular ejection fraction, presence of SHD, acute procedural success (noninducibility of any VT), major complications, need for nonradiofrequency ablation modalities, and VA recurrence were independently associated with all-cause mortality. Conclusion Long-term follow-up after VT ablation shows excellent prognosis in the absence of SHD, highest VA recurrence, and transplantation in patients with NICM and highest mortality in patients with ICM. The extremely low mortality for those without SHD suggests that VT in this population is rarely an initial presentation of a myopathic process.
AB - Background Long-term outcomes after ventricular tachycardia (VT) ablation are sparsely described. Objectives The purpose of this study was to describe long-term prognosis after VT ablation in patients with no structural heart disease (no SHD), ischemic cardiomyopathy (ICM), and nonischemic cardiomyopathy (NICM). Methods Consecutive patients (N = 695: no SHD, 98; ICM, 358; NICM, 239) ablated for sustained VT were followed for a median of 6 years. Acute procedural parameters (complete success [noninducibility of any VT]) and outcomes after multiple procedures were reported. Results Compared with patients with no SHD or NICM, patients with ICM were the oldest, were more likely to be men, lowest left ventricular ejection fraction, highest drug failures, VT storms, and number of inducible VTs. Complete procedure success was highest in patients with no SHD than in patients with ICM and those with NICM (79%, 56%, 60%, respectively; P < .001). At 6 years, ventricular arrhythmia (VA)–free survival was highest in patients with no SHD (77%) than in patients with ICM (54%) and those with NICM (38%) (P < .001), and overall survival was lowest in patients with ICM (48%), followed by patients with NICM (74%) and patients with no SHD (100%) (P < .001). Age, left ventricular ejection fraction, presence of SHD, acute procedural success (noninducibility of any VT), major complications, need for nonradiofrequency ablation modalities, and VA recurrence were independently associated with all-cause mortality. Conclusion Long-term follow-up after VT ablation shows excellent prognosis in the absence of SHD, highest VA recurrence, and transplantation in patients with NICM and highest mortality in patients with ICM. The extremely low mortality for those without SHD suggests that VT in this population is rarely an initial presentation of a myopathic process.
KW - Catheter ablation
KW - Ischemic cardiomyopathy
KW - Nonischemic cardiomyopathy
KW - Structural heart disease
KW - Ventricular tachycardia
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U2 - 10.1016/j.hrthm.2016.07.001
DO - 10.1016/j.hrthm.2016.07.001
M3 - Article
C2 - 27392945
AN - SCOPUS:84994291721
SN - 1547-5271
VL - 13
SP - 1957
EP - 1963
JO - Heart Rhythm
JF - Heart Rhythm
IS - 10
ER -