Ventricular Tachycardia Ablation in the Elderly: An International Ventricular Tachycardia Center Collaborative Group Analysis

Kairav Vakil, Santiago Garcia, Roderick Tung, Marmar Vaseghi, Usha Tedrow, Paolo Della Bella, David S. Frankel, Pasquale Vergara, Luigi Di Biase, Koichi Nagashima, Shiro Nakahara, Wendy S. Tzou, J. David Burkhardt, Timm Dickfeld, J. Peter Weiss, Jared Bunch, David Callans, Dhanunjaya Lakkireddy, Andrea Natale, William H. SauerWilliam G. Stevenson, Francis Marchlinski, Kalyanam Shivkumar, Venkatakrishna N. Tholakanahalli

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background Successful ventricular tachycardia (VT) ablation is associated with improved survival in patients with heart failure. However, the safety and efficacy of VT ablation in the elderly, a population with higher competing nonsudden death risk and comorbidities, have not been well defined. Methods and Results The International Ventricular Tachycardia Center Collaborative Study Group registry of 2061 patients who underwent VT ablation at 12 international centers was analyzed. Kaplan-Meier analysis was used to estimate survival of patients ≥70 years with and without VT recurrence. Of the 2049 patients who met inclusion criteria, 681 (33%) patients were ≥70 years of age (mean age, 75±4 years). Among these, 92% were men, 71% had ischemic VT, and 42% had VT storm at presentation. Mean (±SD) left ventricular ejection fraction was 30±11%. Compared with patients <70 years, patients ≥70 years had higher in-hospital (4.4% versus 2.3%; P=0.01) and 1-year mortality (15% versus 11%; P=0.002) but a similar incidence of VT recurrence at 1 year (26% versus 25%; P=0.74) and time to VT recurrence (280 versus 289 days; P=0.20). Absence of VT recurrence during follow-up was strongly associated with improved survival in patients ≥70 years. Conclusion VT ablation in the elderly is feasible and reasonably safe with a modestly higher in-hospital and 1-year mortality, with similar rates of VT recurrence at 1 year compared with younger patients. Successful VT ablation, that is, lack of VT recurrence, is strongly associated with improved survival even in this elderly subgroup.

Original languageEnglish (US)
Article numbere005332
JournalCirculation: Arrhythmia and Electrophysiology
Volume10
Issue number12
DOIs
StatePublished - Dec 1 2017
Externally publishedYes

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Ventricular Tachycardia
Recurrence
Survival
Mortality
Kaplan-Meier Estimate
Stroke Volume
Registries
Comorbidity
Heart Failure

Keywords

  • Aged
  • catheter ablation
  • heart failure
  • tachycardia, ventricular
  • ventricular fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Ventricular Tachycardia Ablation in the Elderly : An International Ventricular Tachycardia Center Collaborative Group Analysis. / Vakil, Kairav; Garcia, Santiago; Tung, Roderick; Vaseghi, Marmar; Tedrow, Usha; Della Bella, Paolo; Frankel, David S.; Vergara, Pasquale; Di Biase, Luigi; Nagashima, Koichi; Nakahara, Shiro; Tzou, Wendy S.; Burkhardt, J. David; Dickfeld, Timm; Weiss, J. Peter; Bunch, Jared; Callans, David; Lakkireddy, Dhanunjaya; Natale, Andrea; Sauer, William H.; Stevenson, William G.; Marchlinski, Francis; Shivkumar, Kalyanam; Tholakanahalli, Venkatakrishna N.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 10, No. 12, e005332, 01.12.2017.

Research output: Contribution to journalArticle

Vakil, K, Garcia, S, Tung, R, Vaseghi, M, Tedrow, U, Della Bella, P, Frankel, DS, Vergara, P, Di Biase, L, Nagashima, K, Nakahara, S, Tzou, WS, Burkhardt, JD, Dickfeld, T, Weiss, JP, Bunch, J, Callans, D, Lakkireddy, D, Natale, A, Sauer, WH, Stevenson, WG, Marchlinski, F, Shivkumar, K & Tholakanahalli, VN 2017, 'Ventricular Tachycardia Ablation in the Elderly: An International Ventricular Tachycardia Center Collaborative Group Analysis', Circulation: Arrhythmia and Electrophysiology, vol. 10, no. 12, e005332. https://doi.org/10.1161/CIRCEP.117.005332
Vakil, Kairav ; Garcia, Santiago ; Tung, Roderick ; Vaseghi, Marmar ; Tedrow, Usha ; Della Bella, Paolo ; Frankel, David S. ; Vergara, Pasquale ; Di Biase, Luigi ; Nagashima, Koichi ; Nakahara, Shiro ; Tzou, Wendy S. ; Burkhardt, J. David ; Dickfeld, Timm ; Weiss, J. Peter ; Bunch, Jared ; Callans, David ; Lakkireddy, Dhanunjaya ; Natale, Andrea ; Sauer, William H. ; Stevenson, William G. ; Marchlinski, Francis ; Shivkumar, Kalyanam ; Tholakanahalli, Venkatakrishna N. / Ventricular Tachycardia Ablation in the Elderly : An International Ventricular Tachycardia Center Collaborative Group Analysis. In: Circulation: Arrhythmia and Electrophysiology. 2017 ; Vol. 10, No. 12.
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abstract = "Background Successful ventricular tachycardia (VT) ablation is associated with improved survival in patients with heart failure. However, the safety and efficacy of VT ablation in the elderly, a population with higher competing nonsudden death risk and comorbidities, have not been well defined. Methods and Results The International Ventricular Tachycardia Center Collaborative Study Group registry of 2061 patients who underwent VT ablation at 12 international centers was analyzed. Kaplan-Meier analysis was used to estimate survival of patients ≥70 years with and without VT recurrence. Of the 2049 patients who met inclusion criteria, 681 (33{\%}) patients were ≥70 years of age (mean age, 75±4 years). Among these, 92{\%} were men, 71{\%} had ischemic VT, and 42{\%} had VT storm at presentation. Mean (±SD) left ventricular ejection fraction was 30±11{\%}. Compared with patients <70 years, patients ≥70 years had higher in-hospital (4.4{\%} versus 2.3{\%}; P=0.01) and 1-year mortality (15{\%} versus 11{\%}; P=0.002) but a similar incidence of VT recurrence at 1 year (26{\%} versus 25{\%}; P=0.74) and time to VT recurrence (280 versus 289 days; P=0.20). Absence of VT recurrence during follow-up was strongly associated with improved survival in patients ≥70 years. Conclusion VT ablation in the elderly is feasible and reasonably safe with a modestly higher in-hospital and 1-year mortality, with similar rates of VT recurrence at 1 year compared with younger patients. Successful VT ablation, that is, lack of VT recurrence, is strongly associated with improved survival even in this elderly subgroup.",
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author = "Kairav Vakil and Santiago Garcia and Roderick Tung and Marmar Vaseghi and Usha Tedrow and {Della Bella}, Paolo and Frankel, {David S.} and Pasquale Vergara and {Di Biase}, Luigi and Koichi Nagashima and Shiro Nakahara and Tzou, {Wendy S.} and Burkhardt, {J. David} and Timm Dickfeld and Weiss, {J. Peter} and Jared Bunch and David Callans and Dhanunjaya Lakkireddy and Andrea Natale and Sauer, {William H.} and Stevenson, {William G.} and Francis Marchlinski and Kalyanam Shivkumar and Tholakanahalli, {Venkatakrishna N.}",
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T1 - Ventricular Tachycardia Ablation in the Elderly

T2 - An International Ventricular Tachycardia Center Collaborative Group Analysis

AU - Vakil, Kairav

AU - Garcia, Santiago

AU - Tung, Roderick

AU - Vaseghi, Marmar

AU - Tedrow, Usha

AU - Della Bella, Paolo

AU - Frankel, David S.

AU - Vergara, Pasquale

AU - Di Biase, Luigi

AU - Nagashima, Koichi

AU - Nakahara, Shiro

AU - Tzou, Wendy S.

AU - Burkhardt, J. David

AU - Dickfeld, Timm

AU - Weiss, J. Peter

AU - Bunch, Jared

AU - Callans, David

AU - Lakkireddy, Dhanunjaya

AU - Natale, Andrea

AU - Sauer, William H.

AU - Stevenson, William G.

AU - Marchlinski, Francis

AU - Shivkumar, Kalyanam

AU - Tholakanahalli, Venkatakrishna N.

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Background Successful ventricular tachycardia (VT) ablation is associated with improved survival in patients with heart failure. However, the safety and efficacy of VT ablation in the elderly, a population with higher competing nonsudden death risk and comorbidities, have not been well defined. Methods and Results The International Ventricular Tachycardia Center Collaborative Study Group registry of 2061 patients who underwent VT ablation at 12 international centers was analyzed. Kaplan-Meier analysis was used to estimate survival of patients ≥70 years with and without VT recurrence. Of the 2049 patients who met inclusion criteria, 681 (33%) patients were ≥70 years of age (mean age, 75±4 years). Among these, 92% were men, 71% had ischemic VT, and 42% had VT storm at presentation. Mean (±SD) left ventricular ejection fraction was 30±11%. Compared with patients <70 years, patients ≥70 years had higher in-hospital (4.4% versus 2.3%; P=0.01) and 1-year mortality (15% versus 11%; P=0.002) but a similar incidence of VT recurrence at 1 year (26% versus 25%; P=0.74) and time to VT recurrence (280 versus 289 days; P=0.20). Absence of VT recurrence during follow-up was strongly associated with improved survival in patients ≥70 years. Conclusion VT ablation in the elderly is feasible and reasonably safe with a modestly higher in-hospital and 1-year mortality, with similar rates of VT recurrence at 1 year compared with younger patients. Successful VT ablation, that is, lack of VT recurrence, is strongly associated with improved survival even in this elderly subgroup.

AB - Background Successful ventricular tachycardia (VT) ablation is associated with improved survival in patients with heart failure. However, the safety and efficacy of VT ablation in the elderly, a population with higher competing nonsudden death risk and comorbidities, have not been well defined. Methods and Results The International Ventricular Tachycardia Center Collaborative Study Group registry of 2061 patients who underwent VT ablation at 12 international centers was analyzed. Kaplan-Meier analysis was used to estimate survival of patients ≥70 years with and without VT recurrence. Of the 2049 patients who met inclusion criteria, 681 (33%) patients were ≥70 years of age (mean age, 75±4 years). Among these, 92% were men, 71% had ischemic VT, and 42% had VT storm at presentation. Mean (±SD) left ventricular ejection fraction was 30±11%. Compared with patients <70 years, patients ≥70 years had higher in-hospital (4.4% versus 2.3%; P=0.01) and 1-year mortality (15% versus 11%; P=0.002) but a similar incidence of VT recurrence at 1 year (26% versus 25%; P=0.74) and time to VT recurrence (280 versus 289 days; P=0.20). Absence of VT recurrence during follow-up was strongly associated with improved survival in patients ≥70 years. Conclusion VT ablation in the elderly is feasible and reasonably safe with a modestly higher in-hospital and 1-year mortality, with similar rates of VT recurrence at 1 year compared with younger patients. Successful VT ablation, that is, lack of VT recurrence, is strongly associated with improved survival even in this elderly subgroup.

KW - Aged

KW - catheter ablation

KW - heart failure

KW - tachycardia, ventricular

KW - ventricular fibrillation

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