Sex and Catheter Ablation for Ventricular Tachycardia: An International Ventricular Tachycardia Ablation Center Collaborative Group Study

David S. Frankel, Roderick Tung, Pasquale Santangeli, Wendy S. Tzou, Marmar Vaseghi, Luigi Di Biase, Koichi Nagashima, Usha Tedrow, T. Jared Bunch, Venkatakrishna N. Tholakanahalli, Raghuveer Dendi, Madhu Reddy, Dhanunjaya Lakkireddy, Timm Dickfeld, J. Peter Weiss, Nilesh Mathuria, Pasquale Vergara, Mehul Patel, Shiro Nakahara, Kairav VakilWilliam H. Sauer, David J. Callans, Andrea Natale, William G. Stevenson, Paolo Della Bella, Kalyanam Shivkumar, Francis E. Marchlinski

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Importance: Significant differences have been described between women and men regarding presentation, mechanism, and treatment outcome of certain arrhythmias. Previous studies of ventricular tachycardia (VT) ablation have not included sufficient women for meaningful comparison.

Objective: To compare outcomes between women and men with structural heart disease undergoing VT ablation.

Design, Setting, and Participants: Investigator-initiated, multicenter, observational study performed between 2002 and 2013, conducted by the International VT Ablation Center Collaborative Group, consisting of 12 high-volume ablation centers. Consecutive patients with structural heart disease undergoing VT ablation were studied. Structural heart disease was defined as left ventricular ejection fraction less than 55%, hypertrophic cardiomyopathy, or right ventricular cardiomyopathy, with scar confirmed during electroanatomic mapping.

Exposures: Catheter ablation.

Main Outcomes and Measures: Ventricular tachycardia-free survival and transplant-free survival were compared between women and men. Cox proportional hazard modeling was performed.

Results: Of 2062 patients undergoing ablation, 266 (12.9%) were women. Mean (SD) age was 62.4 (13.3) years and 1095 (53.1%) had ischemic cardiomyopathy. Compared with men, women were younger, with higher left ventricular ejection fraction and less VT storm. Despite this, women had higher rates of 1-year VT recurrence following ablation (30.5% vs 25.3%; P = .03). This difference was only partially explained by higher prevalence of nonischemic cardiomyopathy among women and was actually most pronounced among those with ischemic cardiomyopathy.

Conclusions and Relevance: In 12 high-volume ablation centers, women with structural heart disease have worse VT-free survival following ablation than men. Whether this is owing to differences in referral pattern, arrhythmia substrate, or undertreatment requires further study.

Original languageEnglish (US)
Pages (from-to)938-944
Number of pages7
JournalJAMA Cardiology
Volume1
Issue number8
DOIs
StatePublished - Nov 1 2016

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Catheter Ablation
Ventricular Tachycardia
Cardiomyopathies
Heart Diseases
Stroke Volume
Survival
Cardiac Arrhythmias
Hypertrophic Cardiomyopathy
Multicenter Studies
Cicatrix
Observational Studies
Referral and Consultation
Research Personnel
Outcome Assessment (Health Care)
Transplants
Recurrence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Sex and Catheter Ablation for Ventricular Tachycardia : An International Ventricular Tachycardia Ablation Center Collaborative Group Study. / Frankel, David S.; Tung, Roderick; Santangeli, Pasquale; Tzou, Wendy S.; Vaseghi, Marmar; Di Biase, Luigi; Nagashima, Koichi; Tedrow, Usha; Bunch, T. Jared; Tholakanahalli, Venkatakrishna N.; Dendi, Raghuveer; Reddy, Madhu; Lakkireddy, Dhanunjaya; Dickfeld, Timm; Weiss, J. Peter; Mathuria, Nilesh; Vergara, Pasquale; Patel, Mehul; Nakahara, Shiro; Vakil, Kairav; Sauer, William H.; Callans, David J.; Natale, Andrea; Stevenson, William G.; Della Bella, Paolo; Shivkumar, Kalyanam; Marchlinski, Francis E.

In: JAMA Cardiology, Vol. 1, No. 8, 01.11.2016, p. 938-944.

Research output: Contribution to journalArticle

Frankel, DS, Tung, R, Santangeli, P, Tzou, WS, Vaseghi, M, Di Biase, L, Nagashima, K, Tedrow, U, Bunch, TJ, Tholakanahalli, VN, Dendi, R, Reddy, M, Lakkireddy, D, Dickfeld, T, Weiss, JP, Mathuria, N, Vergara, P, Patel, M, Nakahara, S, Vakil, K, Sauer, WH, Callans, DJ, Natale, A, Stevenson, WG, Della Bella, P, Shivkumar, K & Marchlinski, FE 2016, 'Sex and Catheter Ablation for Ventricular Tachycardia: An International Ventricular Tachycardia Ablation Center Collaborative Group Study', JAMA Cardiology, vol. 1, no. 8, pp. 938-944. https://doi.org/10.1001/jamacardio.2016.2361
Frankel, David S. ; Tung, Roderick ; Santangeli, Pasquale ; Tzou, Wendy S. ; Vaseghi, Marmar ; Di Biase, Luigi ; Nagashima, Koichi ; Tedrow, Usha ; Bunch, T. Jared ; Tholakanahalli, Venkatakrishna N. ; Dendi, Raghuveer ; Reddy, Madhu ; Lakkireddy, Dhanunjaya ; Dickfeld, Timm ; Weiss, J. Peter ; Mathuria, Nilesh ; Vergara, Pasquale ; Patel, Mehul ; Nakahara, Shiro ; Vakil, Kairav ; Sauer, William H. ; Callans, David J. ; Natale, Andrea ; Stevenson, William G. ; Della Bella, Paolo ; Shivkumar, Kalyanam ; Marchlinski, Francis E. / Sex and Catheter Ablation for Ventricular Tachycardia : An International Ventricular Tachycardia Ablation Center Collaborative Group Study. In: JAMA Cardiology. 2016 ; Vol. 1, No. 8. pp. 938-944.
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abstract = "Importance: Significant differences have been described between women and men regarding presentation, mechanism, and treatment outcome of certain arrhythmias. Previous studies of ventricular tachycardia (VT) ablation have not included sufficient women for meaningful comparison.Objective: To compare outcomes between women and men with structural heart disease undergoing VT ablation.Design, Setting, and Participants: Investigator-initiated, multicenter, observational study performed between 2002 and 2013, conducted by the International VT Ablation Center Collaborative Group, consisting of 12 high-volume ablation centers. Consecutive patients with structural heart disease undergoing VT ablation were studied. Structural heart disease was defined as left ventricular ejection fraction less than 55{\%}, hypertrophic cardiomyopathy, or right ventricular cardiomyopathy, with scar confirmed during electroanatomic mapping.Exposures: Catheter ablation.Main Outcomes and Measures: Ventricular tachycardia-free survival and transplant-free survival were compared between women and men. Cox proportional hazard modeling was performed.Results: Of 2062 patients undergoing ablation, 266 (12.9{\%}) were women. Mean (SD) age was 62.4 (13.3) years and 1095 (53.1{\%}) had ischemic cardiomyopathy. Compared with men, women were younger, with higher left ventricular ejection fraction and less VT storm. Despite this, women had higher rates of 1-year VT recurrence following ablation (30.5{\%} vs 25.3{\%}; P = .03). This difference was only partially explained by higher prevalence of nonischemic cardiomyopathy among women and was actually most pronounced among those with ischemic cardiomyopathy.Conclusions and Relevance: In 12 high-volume ablation centers, women with structural heart disease have worse VT-free survival following ablation than men. Whether this is owing to differences in referral pattern, arrhythmia substrate, or undertreatment requires further study.",
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T1 - Sex and Catheter Ablation for Ventricular Tachycardia

T2 - An International Ventricular Tachycardia Ablation Center Collaborative Group Study

AU - Frankel, David S.

AU - Tung, Roderick

AU - Santangeli, Pasquale

AU - Tzou, Wendy S.

AU - Vaseghi, Marmar

AU - Di Biase, Luigi

AU - Nagashima, Koichi

AU - Tedrow, Usha

AU - Bunch, T. Jared

AU - Tholakanahalli, Venkatakrishna N.

AU - Dendi, Raghuveer

AU - Reddy, Madhu

AU - Lakkireddy, Dhanunjaya

AU - Dickfeld, Timm

AU - Weiss, J. Peter

AU - Mathuria, Nilesh

AU - Vergara, Pasquale

AU - Patel, Mehul

AU - Nakahara, Shiro

AU - Vakil, Kairav

AU - Sauer, William H.

AU - Callans, David J.

AU - Natale, Andrea

AU - Stevenson, William G.

AU - Della Bella, Paolo

AU - Shivkumar, Kalyanam

AU - Marchlinski, Francis E.

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Importance: Significant differences have been described between women and men regarding presentation, mechanism, and treatment outcome of certain arrhythmias. Previous studies of ventricular tachycardia (VT) ablation have not included sufficient women for meaningful comparison.Objective: To compare outcomes between women and men with structural heart disease undergoing VT ablation.Design, Setting, and Participants: Investigator-initiated, multicenter, observational study performed between 2002 and 2013, conducted by the International VT Ablation Center Collaborative Group, consisting of 12 high-volume ablation centers. Consecutive patients with structural heart disease undergoing VT ablation were studied. Structural heart disease was defined as left ventricular ejection fraction less than 55%, hypertrophic cardiomyopathy, or right ventricular cardiomyopathy, with scar confirmed during electroanatomic mapping.Exposures: Catheter ablation.Main Outcomes and Measures: Ventricular tachycardia-free survival and transplant-free survival were compared between women and men. Cox proportional hazard modeling was performed.Results: Of 2062 patients undergoing ablation, 266 (12.9%) were women. Mean (SD) age was 62.4 (13.3) years and 1095 (53.1%) had ischemic cardiomyopathy. Compared with men, women were younger, with higher left ventricular ejection fraction and less VT storm. Despite this, women had higher rates of 1-year VT recurrence following ablation (30.5% vs 25.3%; P = .03). This difference was only partially explained by higher prevalence of nonischemic cardiomyopathy among women and was actually most pronounced among those with ischemic cardiomyopathy.Conclusions and Relevance: In 12 high-volume ablation centers, women with structural heart disease have worse VT-free survival following ablation than men. Whether this is owing to differences in referral pattern, arrhythmia substrate, or undertreatment requires further study.

AB - Importance: Significant differences have been described between women and men regarding presentation, mechanism, and treatment outcome of certain arrhythmias. Previous studies of ventricular tachycardia (VT) ablation have not included sufficient women for meaningful comparison.Objective: To compare outcomes between women and men with structural heart disease undergoing VT ablation.Design, Setting, and Participants: Investigator-initiated, multicenter, observational study performed between 2002 and 2013, conducted by the International VT Ablation Center Collaborative Group, consisting of 12 high-volume ablation centers. Consecutive patients with structural heart disease undergoing VT ablation were studied. Structural heart disease was defined as left ventricular ejection fraction less than 55%, hypertrophic cardiomyopathy, or right ventricular cardiomyopathy, with scar confirmed during electroanatomic mapping.Exposures: Catheter ablation.Main Outcomes and Measures: Ventricular tachycardia-free survival and transplant-free survival were compared between women and men. Cox proportional hazard modeling was performed.Results: Of 2062 patients undergoing ablation, 266 (12.9%) were women. Mean (SD) age was 62.4 (13.3) years and 1095 (53.1%) had ischemic cardiomyopathy. Compared with men, women were younger, with higher left ventricular ejection fraction and less VT storm. Despite this, women had higher rates of 1-year VT recurrence following ablation (30.5% vs 25.3%; P = .03). This difference was only partially explained by higher prevalence of nonischemic cardiomyopathy among women and was actually most pronounced among those with ischemic cardiomyopathy.Conclusions and Relevance: In 12 high-volume ablation centers, women with structural heart disease have worse VT-free survival following ablation than men. Whether this is owing to differences in referral pattern, arrhythmia substrate, or undertreatment requires further study.

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