Outcomes after repeat ablation of ventricular tachycardia in structural heart disease: An analysis from the International VT Ablation Center Collaborative Group

Wendy S. Tzou, Roderick Tung, David S. Frankel, Luigi Di Biase, Pasquale Santangeli, Marmar Vaseghi, T. Jared Bunch, J. Peter Weiss, Venkatakrishna N. Tholakanahalli, Dhanunjaya Lakkireddy, Rama Vunnam, Timm Dickfeld, Nilesh Mathuria, Usha Tedrow, Pasquale Vergara, Kairav Vakil, Shiro Nakahara, J. David Burkhardt, William G. Stevenson, David J. CallansPaolo Della Bella, Andrea Natale, Kalyanam Shivkumar, Francis E. Marchlinski, William H. Sauer

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Abstract

Background Data evaluating repeat radiofrequency ablation (>1RFA) of ventricular tachycardia (VT) are limited. Objective The purpose of this study was to determine the safety and outcomes of VT >1RFA in patients with structural heart disease. Methods Patients with structural heart disease undergoing VT RFA at 12 centers with data on prior RFA history were included. Characteristics and outcomes were compared between first-time (1RFA) and >1RFA patients. Results Of 1990 patients, 740 had >1RFA (mean 1.4 ± 0.9, range 1–10). >1RFA vs 1RFA patients did not differ with regard to age (62 ± 13 years vs 62 ± 13 years), left ventricular ejection fraction (33% ± 13% vs 34% ± 13%), or sex (88% vs 87% men), but they more often were nonischemic (53% vs 41%), had implantable cardioverter–defibrillator shocks (70% vs 63%) or VT storm (38% vs 33%), and had been treated with amiodarone (55% vs 48%) or ≥2 antiarrhythmic drugs (22% vs 14%). >1RFA procedures were longer (300 ± 122 minutes vs 266 ± 110 minutes), involved more epicardial access (41% vs 21%), induced VTs (2.4 ± 2.2 vs 1.9 ± 1.6) and only unmappable VTs (15% vs 9%), and VT was more often inducible after RFA (42% vs 33%, all P <.03). Total complications were higher for >1RFA vs 1RFA (8% vs 5%, P <.01), mostly related to pericardial effusion (2.4% vs 1.3%, P =.07) and venous thrombosis (0.8% vs 0.2%, P =.06). VT recurrence was higher for >1RFA vs 1RFA (29% vs 24%, P <.001). Survival was worse for >1RFA vs 1RFA if VT recurred (67% vs 78%, P =.003) but was equivalent if successful (93% vs 92%, P =.96). Conclusion Patients requiring repeat VT ablation differ significantly from those undergoing first-time ablation. Despite more challenging ablation characteristics, VT-free survival after repeat ablations is encouraging. Mortality is comparable if VT does not recur after RFA at specialized centers.

Original languageEnglish (US)
Pages (from-to)991-997
Number of pages7
JournalHeart Rhythm
Volume14
Issue number7
DOIs
StatePublished - Jul 2017

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Ventricular Tachycardia
Heart Diseases
Amiodarone
Anti-Arrhythmia Agents
Stroke Volume
Shock
History
Safety
Survival
Mortality

Keywords

  • Ablation outcomes
  • Catheter ablation
  • Ventricular tachycardia

Cite this

Outcomes after repeat ablation of ventricular tachycardia in structural heart disease : An analysis from the International VT Ablation Center Collaborative Group. / Tzou, Wendy S.; Tung, Roderick; Frankel, David S.; Di Biase, Luigi; Santangeli, Pasquale; Vaseghi, Marmar; Bunch, T. Jared; Weiss, J. Peter; Tholakanahalli, Venkatakrishna N.; Lakkireddy, Dhanunjaya; Vunnam, Rama; Dickfeld, Timm; Mathuria, Nilesh; Tedrow, Usha; Vergara, Pasquale; Vakil, Kairav; Nakahara, Shiro; Burkhardt, J. David; Stevenson, William G.; Callans, David J.; Della Bella, Paolo; Natale, Andrea; Shivkumar, Kalyanam; Marchlinski, Francis E.; Sauer, William H.

In: Heart Rhythm, Vol. 14, No. 7, 07.2017, p. 991-997.

Research output: Contribution to journalArticle

Tzou, WS, Tung, R, Frankel, DS, Di Biase, L, Santangeli, P, Vaseghi, M, Bunch, TJ, Weiss, JP, Tholakanahalli, VN, Lakkireddy, D, Vunnam, R, Dickfeld, T, Mathuria, N, Tedrow, U, Vergara, P, Vakil, K, Nakahara, S, Burkhardt, JD, Stevenson, WG, Callans, DJ, Della Bella, P, Natale, A, Shivkumar, K, Marchlinski, FE & Sauer, WH 2017, 'Outcomes after repeat ablation of ventricular tachycardia in structural heart disease: An analysis from the International VT Ablation Center Collaborative Group', Heart Rhythm, vol. 14, no. 7, pp. 991-997. https://doi.org/10.1016/j.hrthm.2017.03.008
Tzou, Wendy S. ; Tung, Roderick ; Frankel, David S. ; Di Biase, Luigi ; Santangeli, Pasquale ; Vaseghi, Marmar ; Bunch, T. Jared ; Weiss, J. Peter ; Tholakanahalli, Venkatakrishna N. ; Lakkireddy, Dhanunjaya ; Vunnam, Rama ; Dickfeld, Timm ; Mathuria, Nilesh ; Tedrow, Usha ; Vergara, Pasquale ; Vakil, Kairav ; Nakahara, Shiro ; Burkhardt, J. David ; Stevenson, William G. ; Callans, David J. ; Della Bella, Paolo ; Natale, Andrea ; Shivkumar, Kalyanam ; Marchlinski, Francis E. ; Sauer, William H. / Outcomes after repeat ablation of ventricular tachycardia in structural heart disease : An analysis from the International VT Ablation Center Collaborative Group. In: Heart Rhythm. 2017 ; Vol. 14, No. 7. pp. 991-997.
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abstract = "Background Data evaluating repeat radiofrequency ablation (>1RFA) of ventricular tachycardia (VT) are limited. Objective The purpose of this study was to determine the safety and outcomes of VT >1RFA in patients with structural heart disease. Methods Patients with structural heart disease undergoing VT RFA at 12 centers with data on prior RFA history were included. Characteristics and outcomes were compared between first-time (1RFA) and >1RFA patients. Results Of 1990 patients, 740 had >1RFA (mean 1.4 ± 0.9, range 1–10). >1RFA vs 1RFA patients did not differ with regard to age (62 ± 13 years vs 62 ± 13 years), left ventricular ejection fraction (33{\%} ± 13{\%} vs 34{\%} ± 13{\%}), or sex (88{\%} vs 87{\%} men), but they more often were nonischemic (53{\%} vs 41{\%}), had implantable cardioverter–defibrillator shocks (70{\%} vs 63{\%}) or VT storm (38{\%} vs 33{\%}), and had been treated with amiodarone (55{\%} vs 48{\%}) or ≥2 antiarrhythmic drugs (22{\%} vs 14{\%}). >1RFA procedures were longer (300 ± 122 minutes vs 266 ± 110 minutes), involved more epicardial access (41{\%} vs 21{\%}), induced VTs (2.4 ± 2.2 vs 1.9 ± 1.6) and only unmappable VTs (15{\%} vs 9{\%}), and VT was more often inducible after RFA (42{\%} vs 33{\%}, all P <.03). Total complications were higher for >1RFA vs 1RFA (8{\%} vs 5{\%}, P <.01), mostly related to pericardial effusion (2.4{\%} vs 1.3{\%}, P =.07) and venous thrombosis (0.8{\%} vs 0.2{\%}, P =.06). VT recurrence was higher for >1RFA vs 1RFA (29{\%} vs 24{\%}, P <.001). Survival was worse for >1RFA vs 1RFA if VT recurred (67{\%} vs 78{\%}, P =.003) but was equivalent if successful (93{\%} vs 92{\%}, P =.96). Conclusion Patients requiring repeat VT ablation differ significantly from those undergoing first-time ablation. Despite more challenging ablation characteristics, VT-free survival after repeat ablations is encouraging. Mortality is comparable if VT does not recur after RFA at specialized centers.",
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author = "Tzou, {Wendy S.} and Roderick Tung and Frankel, {David S.} and {Di Biase}, Luigi and Pasquale Santangeli and Marmar Vaseghi and Bunch, {T. Jared} and Weiss, {J. Peter} and Tholakanahalli, {Venkatakrishna N.} and Dhanunjaya Lakkireddy and Rama Vunnam and Timm Dickfeld and Nilesh Mathuria and Usha Tedrow and Pasquale Vergara and Kairav Vakil and Shiro Nakahara and Burkhardt, {J. David} and Stevenson, {William G.} and Callans, {David J.} and {Della Bella}, Paolo and Andrea Natale and Kalyanam Shivkumar and Marchlinski, {Francis E.} and Sauer, {William H.}",
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TY - JOUR

T1 - Outcomes after repeat ablation of ventricular tachycardia in structural heart disease

T2 - An analysis from the International VT Ablation Center Collaborative Group

AU - Tzou, Wendy S.

AU - Tung, Roderick

AU - Frankel, David S.

AU - Di Biase, Luigi

AU - Santangeli, Pasquale

AU - Vaseghi, Marmar

AU - Bunch, T. Jared

AU - Weiss, J. Peter

AU - Tholakanahalli, Venkatakrishna N.

AU - Lakkireddy, Dhanunjaya

AU - Vunnam, Rama

AU - Dickfeld, Timm

AU - Mathuria, Nilesh

AU - Tedrow, Usha

AU - Vergara, Pasquale

AU - Vakil, Kairav

AU - Nakahara, Shiro

AU - Burkhardt, J. David

AU - Stevenson, William G.

AU - Callans, David J.

AU - Della Bella, Paolo

AU - Natale, Andrea

AU - Shivkumar, Kalyanam

AU - Marchlinski, Francis E.

AU - Sauer, William H.

PY - 2017/7

Y1 - 2017/7

N2 - Background Data evaluating repeat radiofrequency ablation (>1RFA) of ventricular tachycardia (VT) are limited. Objective The purpose of this study was to determine the safety and outcomes of VT >1RFA in patients with structural heart disease. Methods Patients with structural heart disease undergoing VT RFA at 12 centers with data on prior RFA history were included. Characteristics and outcomes were compared between first-time (1RFA) and >1RFA patients. Results Of 1990 patients, 740 had >1RFA (mean 1.4 ± 0.9, range 1–10). >1RFA vs 1RFA patients did not differ with regard to age (62 ± 13 years vs 62 ± 13 years), left ventricular ejection fraction (33% ± 13% vs 34% ± 13%), or sex (88% vs 87% men), but they more often were nonischemic (53% vs 41%), had implantable cardioverter–defibrillator shocks (70% vs 63%) or VT storm (38% vs 33%), and had been treated with amiodarone (55% vs 48%) or ≥2 antiarrhythmic drugs (22% vs 14%). >1RFA procedures were longer (300 ± 122 minutes vs 266 ± 110 minutes), involved more epicardial access (41% vs 21%), induced VTs (2.4 ± 2.2 vs 1.9 ± 1.6) and only unmappable VTs (15% vs 9%), and VT was more often inducible after RFA (42% vs 33%, all P <.03). Total complications were higher for >1RFA vs 1RFA (8% vs 5%, P <.01), mostly related to pericardial effusion (2.4% vs 1.3%, P =.07) and venous thrombosis (0.8% vs 0.2%, P =.06). VT recurrence was higher for >1RFA vs 1RFA (29% vs 24%, P <.001). Survival was worse for >1RFA vs 1RFA if VT recurred (67% vs 78%, P =.003) but was equivalent if successful (93% vs 92%, P =.96). Conclusion Patients requiring repeat VT ablation differ significantly from those undergoing first-time ablation. Despite more challenging ablation characteristics, VT-free survival after repeat ablations is encouraging. Mortality is comparable if VT does not recur after RFA at specialized centers.

AB - Background Data evaluating repeat radiofrequency ablation (>1RFA) of ventricular tachycardia (VT) are limited. Objective The purpose of this study was to determine the safety and outcomes of VT >1RFA in patients with structural heart disease. Methods Patients with structural heart disease undergoing VT RFA at 12 centers with data on prior RFA history were included. Characteristics and outcomes were compared between first-time (1RFA) and >1RFA patients. Results Of 1990 patients, 740 had >1RFA (mean 1.4 ± 0.9, range 1–10). >1RFA vs 1RFA patients did not differ with regard to age (62 ± 13 years vs 62 ± 13 years), left ventricular ejection fraction (33% ± 13% vs 34% ± 13%), or sex (88% vs 87% men), but they more often were nonischemic (53% vs 41%), had implantable cardioverter–defibrillator shocks (70% vs 63%) or VT storm (38% vs 33%), and had been treated with amiodarone (55% vs 48%) or ≥2 antiarrhythmic drugs (22% vs 14%). >1RFA procedures were longer (300 ± 122 minutes vs 266 ± 110 minutes), involved more epicardial access (41% vs 21%), induced VTs (2.4 ± 2.2 vs 1.9 ± 1.6) and only unmappable VTs (15% vs 9%), and VT was more often inducible after RFA (42% vs 33%, all P <.03). Total complications were higher for >1RFA vs 1RFA (8% vs 5%, P <.01), mostly related to pericardial effusion (2.4% vs 1.3%, P =.07) and venous thrombosis (0.8% vs 0.2%, P =.06). VT recurrence was higher for >1RFA vs 1RFA (29% vs 24%, P <.001). Survival was worse for >1RFA vs 1RFA if VT recurred (67% vs 78%, P =.003) but was equivalent if successful (93% vs 92%, P =.96). Conclusion Patients requiring repeat VT ablation differ significantly from those undergoing first-time ablation. Despite more challenging ablation characteristics, VT-free survival after repeat ablations is encouraging. Mortality is comparable if VT does not recur after RFA at specialized centers.

KW - Ablation outcomes

KW - Catheter ablation

KW - Ventricular tachycardia

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