Early Mortality After Catheter Ablation of Ventricular Tachycardia in Patients With Structural Heart Disease

International VT Ablation Center Collaborative Group

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background In patients referred for radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) in the setting of structural heart disease, early post-procedural mortality (EM) has not been previously investigated. Objectives The purpose of this study was to evaluate EM after catheter ablation of scar-related VT. Methods Associations between clinical and procedural variables and EM (within 31 days of the procedure) were tested in patients with structural heart disease undergoing RFCA of VT at 12 international centers. Results Of 2,061 patients (mean age 62 ± 13 years; left ventricular ejection fraction [LVEF] 34 ± 13%; 53% ischemic etiology), EM occurred in 100 (5%; 95% confidence interval [CI]: 4% to 6%). A total of 54 (3%) patients died before hospital discharge (median 9 days after the procedure; 25% for refractory VT), including 12 (0.6%) after a major procedure-related complication. In multivariable analysis, the following factors were found to be significantly associated with EM: LVEF (odds ratio [OR] per percent decrease: 1.12; 95% CI: 1.05 to 1.20; p < 0.001), chronic kidney disease (OR: 2.73; 95% CI: 1.10 to 6.80; p = 0.030), presentation with VT storm (OR: 3.61; 95% CI: 1.37 to 9.48; p = 0.009), and presence of unmappable VTs (OR: 5.69; 95% CI: 1.37 to 23.69; p = 0.017). Recurrent VT was also associated with an increased risk of subsequent death (hazard ratio: 7.19; 95% CI: 5.57 to 9.28; p < 0.001) and EM (hazard ratio: 11.45; 95% CI: 7.47 to 17.59; p < 0.001). Conclusions In a contemporary cohort of patients with scar-related VT undergoing RFCA, EM occurred in 5% of cases. Clinical and procedural variables indicating poorer clinical status (low LVEF, chronic kidney disease, VT storm, and unmappable VTs) and post-procedural VT recurrence may predict EM. Identification of such features may prompt early consideration for hemodynamic support or other care to help mitigate later potential complications.

Original languageEnglish (US)
Pages (from-to)2105-2115
Number of pages11
JournalJournal of the American College of Cardiology
Volume69
Issue number17
DOIs
StatePublished - May 2 2017

Fingerprint

Catheter Ablation
Ventricular Tachycardia
Heart Diseases
Mortality
Confidence Intervals
Odds Ratio
Stroke Volume
Chronic Renal Insufficiency
Cicatrix
Hemodynamics
Recurrence

Keywords

  • complications
  • heart failure
  • outcome assessment
  • radiofrequency ablation

Cite this

Early Mortality After Catheter Ablation of Ventricular Tachycardia in Patients With Structural Heart Disease. / International VT Ablation Center Collaborative Group.

In: Journal of the American College of Cardiology, Vol. 69, No. 17, 02.05.2017, p. 2105-2115.

Research output: Contribution to journalArticle

International VT Ablation Center Collaborative Group. / Early Mortality After Catheter Ablation of Ventricular Tachycardia in Patients With Structural Heart Disease. In: Journal of the American College of Cardiology. 2017 ; Vol. 69, No. 17. pp. 2105-2115.
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title = "Early Mortality After Catheter Ablation of Ventricular Tachycardia in Patients With Structural Heart Disease",
abstract = "Background In patients referred for radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) in the setting of structural heart disease, early post-procedural mortality (EM) has not been previously investigated. Objectives The purpose of this study was to evaluate EM after catheter ablation of scar-related VT. Methods Associations between clinical and procedural variables and EM (within 31 days of the procedure) were tested in patients with structural heart disease undergoing RFCA of VT at 12 international centers. Results Of 2,061 patients (mean age 62 ± 13 years; left ventricular ejection fraction [LVEF] 34 ± 13{\%}; 53{\%} ischemic etiology), EM occurred in 100 (5{\%}; 95{\%} confidence interval [CI]: 4{\%} to 6{\%}). A total of 54 (3{\%}) patients died before hospital discharge (median 9 days after the procedure; 25{\%} for refractory VT), including 12 (0.6{\%}) after a major procedure-related complication. In multivariable analysis, the following factors were found to be significantly associated with EM: LVEF (odds ratio [OR] per percent decrease: 1.12; 95{\%} CI: 1.05 to 1.20; p < 0.001), chronic kidney disease (OR: 2.73; 95{\%} CI: 1.10 to 6.80; p = 0.030), presentation with VT storm (OR: 3.61; 95{\%} CI: 1.37 to 9.48; p = 0.009), and presence of unmappable VTs (OR: 5.69; 95{\%} CI: 1.37 to 23.69; p = 0.017). Recurrent VT was also associated with an increased risk of subsequent death (hazard ratio: 7.19; 95{\%} CI: 5.57 to 9.28; p < 0.001) and EM (hazard ratio: 11.45; 95{\%} CI: 7.47 to 17.59; p < 0.001). Conclusions In a contemporary cohort of patients with scar-related VT undergoing RFCA, EM occurred in 5{\%} of cases. Clinical and procedural variables indicating poorer clinical status (low LVEF, chronic kidney disease, VT storm, and unmappable VTs) and post-procedural VT recurrence may predict EM. Identification of such features may prompt early consideration for hemodynamic support or other care to help mitigate later potential complications.",
keywords = "complications, heart failure, outcome assessment, radiofrequency ablation",
author = "{International VT Ablation Center Collaborative Group} and Pasquale Santangeli and Frankel, {David S.} and Roderick Tung and Marmar Vaseghi and Sauer, {William H.} and Tzou, {Wendy S.} and Nilesh Mathuria and Shiro Nakahara and Dickfeldt, {Timm M.} and Dhanunjaya Lakkireddy and Bunch, {T. Jared} and {Di Biase}, Luigi and Andrea Natale and Venkat Tholakanahalli and Tholakanahalli, {Venkatakrishna N} and Tholakanahalli, {Venkatakrishna N} and Tholakanahalli, {Venkatakrishna N} and {Della Bella}, Paolo and Kalyanam Shivkumar and Marchlinski, {Francis E.} and Callans, {David J.}",
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language = "English (US)",
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TY - JOUR

T1 - Early Mortality After Catheter Ablation of Ventricular Tachycardia in Patients With Structural Heart Disease

AU - International VT Ablation Center Collaborative Group

AU - Santangeli, Pasquale

AU - Frankel, David S.

AU - Tung, Roderick

AU - Vaseghi, Marmar

AU - Sauer, William H.

AU - Tzou, Wendy S.

AU - Mathuria, Nilesh

AU - Nakahara, Shiro

AU - Dickfeldt, Timm M.

AU - Lakkireddy, Dhanunjaya

AU - Bunch, T. Jared

AU - Di Biase, Luigi

AU - Natale, Andrea

AU - Tholakanahalli, Venkat

AU - Tholakanahalli, Venkatakrishna N

AU - Tholakanahalli, Venkatakrishna N

AU - Tholakanahalli, Venkatakrishna N

AU - Della Bella, Paolo

AU - Shivkumar, Kalyanam

AU - Marchlinski, Francis E.

AU - Callans, David J.

PY - 2017/5/2

Y1 - 2017/5/2

N2 - Background In patients referred for radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) in the setting of structural heart disease, early post-procedural mortality (EM) has not been previously investigated. Objectives The purpose of this study was to evaluate EM after catheter ablation of scar-related VT. Methods Associations between clinical and procedural variables and EM (within 31 days of the procedure) were tested in patients with structural heart disease undergoing RFCA of VT at 12 international centers. Results Of 2,061 patients (mean age 62 ± 13 years; left ventricular ejection fraction [LVEF] 34 ± 13%; 53% ischemic etiology), EM occurred in 100 (5%; 95% confidence interval [CI]: 4% to 6%). A total of 54 (3%) patients died before hospital discharge (median 9 days after the procedure; 25% for refractory VT), including 12 (0.6%) after a major procedure-related complication. In multivariable analysis, the following factors were found to be significantly associated with EM: LVEF (odds ratio [OR] per percent decrease: 1.12; 95% CI: 1.05 to 1.20; p < 0.001), chronic kidney disease (OR: 2.73; 95% CI: 1.10 to 6.80; p = 0.030), presentation with VT storm (OR: 3.61; 95% CI: 1.37 to 9.48; p = 0.009), and presence of unmappable VTs (OR: 5.69; 95% CI: 1.37 to 23.69; p = 0.017). Recurrent VT was also associated with an increased risk of subsequent death (hazard ratio: 7.19; 95% CI: 5.57 to 9.28; p < 0.001) and EM (hazard ratio: 11.45; 95% CI: 7.47 to 17.59; p < 0.001). Conclusions In a contemporary cohort of patients with scar-related VT undergoing RFCA, EM occurred in 5% of cases. Clinical and procedural variables indicating poorer clinical status (low LVEF, chronic kidney disease, VT storm, and unmappable VTs) and post-procedural VT recurrence may predict EM. Identification of such features may prompt early consideration for hemodynamic support or other care to help mitigate later potential complications.

AB - Background In patients referred for radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) in the setting of structural heart disease, early post-procedural mortality (EM) has not been previously investigated. Objectives The purpose of this study was to evaluate EM after catheter ablation of scar-related VT. Methods Associations between clinical and procedural variables and EM (within 31 days of the procedure) were tested in patients with structural heart disease undergoing RFCA of VT at 12 international centers. Results Of 2,061 patients (mean age 62 ± 13 years; left ventricular ejection fraction [LVEF] 34 ± 13%; 53% ischemic etiology), EM occurred in 100 (5%; 95% confidence interval [CI]: 4% to 6%). A total of 54 (3%) patients died before hospital discharge (median 9 days after the procedure; 25% for refractory VT), including 12 (0.6%) after a major procedure-related complication. In multivariable analysis, the following factors were found to be significantly associated with EM: LVEF (odds ratio [OR] per percent decrease: 1.12; 95% CI: 1.05 to 1.20; p < 0.001), chronic kidney disease (OR: 2.73; 95% CI: 1.10 to 6.80; p = 0.030), presentation with VT storm (OR: 3.61; 95% CI: 1.37 to 9.48; p = 0.009), and presence of unmappable VTs (OR: 5.69; 95% CI: 1.37 to 23.69; p = 0.017). Recurrent VT was also associated with an increased risk of subsequent death (hazard ratio: 7.19; 95% CI: 5.57 to 9.28; p < 0.001) and EM (hazard ratio: 11.45; 95% CI: 7.47 to 17.59; p < 0.001). Conclusions In a contemporary cohort of patients with scar-related VT undergoing RFCA, EM occurred in 5% of cases. Clinical and procedural variables indicating poorer clinical status (low LVEF, chronic kidney disease, VT storm, and unmappable VTs) and post-procedural VT recurrence may predict EM. Identification of such features may prompt early consideration for hemodynamic support or other care to help mitigate later potential complications.

KW - complications

KW - heart failure

KW - outcome assessment

KW - radiofrequency ablation

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