Predictors of in-hospital mortality after DC catheter ablation of atrioventricular junction: Results of a prospective, international, multicenter study

G. Thomas Evans, Melvin M. Scheinman, Gust Bardy, Martin Borggrefe, Pedro Brugada, John Devens Fisher, Guy Fontaine, S. K Stephen Huang, Wei Hua Huang, Mark Josephson, Karl Heinz Kuck, Mark A. Hlatky, Samuel Lévy, John W. Lister, Frank Marcus, Fred Morady, Patrick Tchou, Albert L. Waldo, Douglas Wood

Research output: Contribution to journalArticle

105 Citations (Scopus)

Abstract

Background. The Catheter Ablation Registry was the first international, multicenter, prospective study of the safety and efficacy of catheter ablation. Methods and Results. From August 1987 through March 1990, the study comprised 136 patients in whom only DC energy was used in attempted production of third-degree atrioventricular block to treat uncontrollable supraventricular tachycardias. Eight patients died during hospitalization for ablation. In seven (5.1%), the ablation may have contributed to their deaths. Causes of death included ventricular fibrillation (five patients, three with polymorphic ventricular tachycardia), progressive heart failure (one patient), and respiratory failure (two patients, one dying after resuscitation from ventricular fibrillation). Compared with survivors, patients who died were more likely to have had prior aborted sudden death (38% versus 2%, p<0.05), congestive heart failure (88% versus 22%, p<0.001), cardiomyopathy (50% versus 16%, p<0.05), lower baseline systolic blood pressure (106 versus 138 mm Hg, p<0.001), prolonged baseline and postablation corrected QT interval (p<0.01), and markedly reduced ejection fraction (27% versus 52%, p<0.001). Ablation successfully produced third-degree atrioventricular block in 88% of the patients who died and in 83% of survivors. Conclusions. Catheter ablation of the atrioventricular junction with DC energy carries a significant, previously unrecognized risk of death (5.1%), particularly from lethal arrhythmias, when applied to patients with severe left ventricular dysfunction. Great care should be taken in these seriously ill patients to guard against postablation ventricular arrhythmias.

Original languageEnglish (US)
Pages (from-to)1924-1937
Number of pages14
JournalCirculation
Volume84
Issue number5
StatePublished - Nov 1991
Externally publishedYes

Fingerprint

Catheter Ablation
Hospital Mortality
Multicenter Studies
Atrioventricular Block
Ventricular Fibrillation
Survivors
Cardiac Arrhythmias
Heart Failure
Blood Pressure
Supraventricular Tachycardia
Left Ventricular Dysfunction
Ventricular Tachycardia
Sudden Death
Cardiomyopathies
Resuscitation
Respiratory Insufficiency
Registries
Cause of Death
Hospitalization
Prospective Studies

Keywords

  • Arrhythmias
  • Polymorphic ventricular tachycardia
  • Supraventricular tachycardia
  • Torsade de pointes

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Evans, G. T., Scheinman, M. M., Bardy, G., Borggrefe, M., Brugada, P., Fisher, J. D., ... Wood, D. (1991). Predictors of in-hospital mortality after DC catheter ablation of atrioventricular junction: Results of a prospective, international, multicenter study. Circulation, 84(5), 1924-1937.

Predictors of in-hospital mortality after DC catheter ablation of atrioventricular junction : Results of a prospective, international, multicenter study. / Evans, G. Thomas; Scheinman, Melvin M.; Bardy, Gust; Borggrefe, Martin; Brugada, Pedro; Fisher, John Devens; Fontaine, Guy; Huang, S. K Stephen; Huang, Wei Hua; Josephson, Mark; Kuck, Karl Heinz; Hlatky, Mark A.; Lévy, Samuel; Lister, John W.; Marcus, Frank; Morady, Fred; Tchou, Patrick; Waldo, Albert L.; Wood, Douglas.

In: Circulation, Vol. 84, No. 5, 11.1991, p. 1924-1937.

Research output: Contribution to journalArticle

Evans, GT, Scheinman, MM, Bardy, G, Borggrefe, M, Brugada, P, Fisher, JD, Fontaine, G, Huang, SKS, Huang, WH, Josephson, M, Kuck, KH, Hlatky, MA, Lévy, S, Lister, JW, Marcus, F, Morady, F, Tchou, P, Waldo, AL & Wood, D 1991, 'Predictors of in-hospital mortality after DC catheter ablation of atrioventricular junction: Results of a prospective, international, multicenter study', Circulation, vol. 84, no. 5, pp. 1924-1937.
Evans, G. Thomas ; Scheinman, Melvin M. ; Bardy, Gust ; Borggrefe, Martin ; Brugada, Pedro ; Fisher, John Devens ; Fontaine, Guy ; Huang, S. K Stephen ; Huang, Wei Hua ; Josephson, Mark ; Kuck, Karl Heinz ; Hlatky, Mark A. ; Lévy, Samuel ; Lister, John W. ; Marcus, Frank ; Morady, Fred ; Tchou, Patrick ; Waldo, Albert L. ; Wood, Douglas. / Predictors of in-hospital mortality after DC catheter ablation of atrioventricular junction : Results of a prospective, international, multicenter study. In: Circulation. 1991 ; Vol. 84, No. 5. pp. 1924-1937.
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abstract = "Background. The Catheter Ablation Registry was the first international, multicenter, prospective study of the safety and efficacy of catheter ablation. Methods and Results. From August 1987 through March 1990, the study comprised 136 patients in whom only DC energy was used in attempted production of third-degree atrioventricular block to treat uncontrollable supraventricular tachycardias. Eight patients died during hospitalization for ablation. In seven (5.1{\%}), the ablation may have contributed to their deaths. Causes of death included ventricular fibrillation (five patients, three with polymorphic ventricular tachycardia), progressive heart failure (one patient), and respiratory failure (two patients, one dying after resuscitation from ventricular fibrillation). Compared with survivors, patients who died were more likely to have had prior aborted sudden death (38{\%} versus 2{\%}, p<0.05), congestive heart failure (88{\%} versus 22{\%}, p<0.001), cardiomyopathy (50{\%} versus 16{\%}, p<0.05), lower baseline systolic blood pressure (106 versus 138 mm Hg, p<0.001), prolonged baseline and postablation corrected QT interval (p<0.01), and markedly reduced ejection fraction (27{\%} versus 52{\%}, p<0.001). Ablation successfully produced third-degree atrioventricular block in 88{\%} of the patients who died and in 83{\%} of survivors. Conclusions. Catheter ablation of the atrioventricular junction with DC energy carries a significant, previously unrecognized risk of death (5.1{\%}), particularly from lethal arrhythmias, when applied to patients with severe left ventricular dysfunction. Great care should be taken in these seriously ill patients to guard against postablation ventricular arrhythmias.",
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AU - Evans, G. Thomas

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AU - Bardy, Gust

AU - Borggrefe, Martin

AU - Brugada, Pedro

AU - Fisher, John Devens

AU - Fontaine, Guy

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AU - Huang, Wei Hua

AU - Josephson, Mark

AU - Kuck, Karl Heinz

AU - Hlatky, Mark A.

AU - Lévy, Samuel

AU - Lister, John W.

AU - Marcus, Frank

AU - Morady, Fred

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AU - Waldo, Albert L.

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N2 - Background. The Catheter Ablation Registry was the first international, multicenter, prospective study of the safety and efficacy of catheter ablation. Methods and Results. From August 1987 through March 1990, the study comprised 136 patients in whom only DC energy was used in attempted production of third-degree atrioventricular block to treat uncontrollable supraventricular tachycardias. Eight patients died during hospitalization for ablation. In seven (5.1%), the ablation may have contributed to their deaths. Causes of death included ventricular fibrillation (five patients, three with polymorphic ventricular tachycardia), progressive heart failure (one patient), and respiratory failure (two patients, one dying after resuscitation from ventricular fibrillation). Compared with survivors, patients who died were more likely to have had prior aborted sudden death (38% versus 2%, p<0.05), congestive heart failure (88% versus 22%, p<0.001), cardiomyopathy (50% versus 16%, p<0.05), lower baseline systolic blood pressure (106 versus 138 mm Hg, p<0.001), prolonged baseline and postablation corrected QT interval (p<0.01), and markedly reduced ejection fraction (27% versus 52%, p<0.001). Ablation successfully produced third-degree atrioventricular block in 88% of the patients who died and in 83% of survivors. Conclusions. Catheter ablation of the atrioventricular junction with DC energy carries a significant, previously unrecognized risk of death (5.1%), particularly from lethal arrhythmias, when applied to patients with severe left ventricular dysfunction. Great care should be taken in these seriously ill patients to guard against postablation ventricular arrhythmias.

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KW - Arrhythmias

KW - Polymorphic ventricular tachycardia

KW - Supraventricular tachycardia

KW - Torsade de pointes

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