Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: An International VT Ablation Center Collaborative Group study

Roderick Tung, Marmar Vaseghi, David S. Frankel, Pasquale Vergara, Luigi Di Biase, Koichi Nagashima, Ricky Yu, Sitaram Vangala, Chi Hong Tseng, Eue Keun Choi, Shaan Khurshid, Mehul Patel, Nilesh Mathuria, Shiro Nakahara, Wendy S. Tzou, William H. Sauer, Kairav Vakil, Usha Tedrow, J. David Burkhardt, Venkatakrishna N TholakanahalliAnastasios Saliaris, Timm Dickfeld, J. Peter Weiss, T. Jared Bunch, Madhu Reddy, Arun Kanmanthareddy, David J. Callans, Dhanunjaya Lakkireddy, Andrea Natale, Francis Marchlinski, William G. Stevenson, Paolo Della Bella, Kalyanam Shivkumar

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277 Scopus citations

Abstract

Background The impact of catheter ablation of ventricular tachycardia (VT) on all-cause mortality remains unknown. Objective The purpose of this study was to examine the association between VT recurrence after ablation and survival in patients with scar-related VT. Methods Analysis of 2061 patients with structural heart disease referred for catheter ablation of scar-related VT from 12 international centers was performed. Data on clinical and procedural variables, VT recurrence, and mortality were analyzed. Kaplan-Meier analysis was used to estimate freedom from recurrent VT, transplant, and death. Cox proportional hazards frailty models were used to analyze the effect of risk factors on VT recurrence and mortality. Results One-year freedom from VT recurrence was 70% (72% in ischemic and 68% in nonischemic cardiomyopathy). Fifty-seven patients (3%) underwent cardiac transplantation, and 216 (10%) died during follow-up. At 1 year, the estimated rate of transplant and/or mortality was 15% (same for ischemic and nonischemic cardiomyopathy). Transplant-free survival was significantly higher in patients without VT recurrence than in those with recurrence (90% vs 71%, P <.001). In multivariable analysis, recurrence of VT after ablation showed the highest risk for transplant and/or mortality [hazard ratio 6.9 (95% CI 5.3-9.0), P <.001]. In patients with ejection fraction <30% and across all New York Heart Association functional classes, improved transplant-free survival was seen in those without VT recurrence. Conclusion Catheter ablation of VT in patients with structural heart disease results in 70% freedom from VT recurrence, with an overall transplant and/or mortality rate of 15% at 1 year. Freedom from VT recurrence is associated with improved transplant-free survival, independent of heart failure severity.

Original languageEnglish (US)
Pages (from-to)1997-2007
Number of pages11
JournalHeart Rhythm
Volume12
Issue number9
DOIs
StatePublished - Sep 1 2015

Bibliographical note

Funding Information:
The following authors contributed equally to this manuscript: Drs. Tung and Vaseghi; Drs. Frankel, Vergara, and DiBiase; and Drs. Natale, Marchlinski, Stevenson, Della Bella, and Shivkumar. The study was an unfunded, investigator-initiated collaborative study. Dr. Shivkumar was supported by National Heart, Lung, and Blood Institute Grant R01HL084261. Dr. Di Biase is a consultant to Biosense Webster, St. Jude Medical, and Stereotaxis. Dr. Nagashima is the recipient of a Medtronic Japan Fellowship. Dr. Tedrow has received honoraria from Medtronic, Boston Scientific, and St. Jude Medical; and research grants from Biosense Webster and St. Jude Medical. Dr. Burkhardt is a consultant to Biosense Webster. Dr. Tholakanahalli has no disclosures relevant to the study. Dr. Dickfeld has received a research grant from, and is a consultant to, Biosense Webster. Dr. Weiss is a consultant to Stereotaxis. Dr. Bunch is a consultant to Boston Scientific. Dr. Stevenson is the recipient of a patent for needle ablation consigned to Brigham and Women’s Hospital. Dr. Della Bella is a consultant to St. Jude Medical; and has received honoraria for lectures from Biosense Webster, St. Jude Medical, and Biotronik.

Publisher Copyright:
© 2015 Heart Rhythm Society.

Keywords

  • Ablation
  • Ventricular tachycardia

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