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. Sauer; William G. Stevenson; Francis Marchlinski; Kalyanam Shivkumar; Venkatakrishna N. Tholakanahalli

doi:10.1161/CIRCEP.117.005332

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

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7 Scopus citations

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 language	English (US)
Article number	e005332
Journal	Circulation: Arrhythmia and Electrophysiology
Volume	10
Issue number	12
DOIs	https://doi.org/10.1161/CIRCEP.117.005332
State	Published - Dec 1 2017

Bibliographical note

Funding Information:
Dr Vakil has received an investigator initiated research grant from Medtronic Inc. Dr Garcia is a consultant for Surmodics and Osprey Medical. Dr Garcia is a recipient of a career development award (1IK2CX000699-01) from the VA Office of Research and Development and a research grant from Minnesota Veterans Research Foundation. Dr Di Biase is a consultant for Biosense Webster, St. Jude Medical, and Hansen Medical. Dr Nagashima has a fellowship with Medtronic Japan. Dr Tedrow receives honoraria from Medtronic, Boston Scientific, St. Jude Medical, and research grants from Biosense Webster and St Jude Medical. Dr Burkhardt is a consultant for Biosense Webster. Dr Tholakanahalli has received grants from the St Jude Medical foundation and Boston Scientific, research studies for Medtronic, Biotronik, Boston Scientific, and St. Jude Medical and holds patents with PATVJA One LLC. Dr Dickfeld has received a research grant from Biosense Webster and is a consultant for Biosense. Dr Weiss is a consultant for Stereotaxis. Dr Stevenson holds the patent for needle ablation consigned to Brigham and Women’s Hospital. Dr Bella is a consultant for St. Jude Medical and receives honoraria for lectures from Biosense Webster, St Jude Medical, and Biotronik. The other authors report no conflicts.

Publisher Copyright:
© 2017 American Heart Association, Inc.

Keywords

Aged
catheter ablation
heart failure
tachycardia, ventricular
ventricular fibrillation

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Vakil, K., Garcia, S., Tung, R., Vaseghi, M., Tedrow, U., Della Bella, P., Frankel, D. S., Vergara, P., Di Biase, L., Nagashima, K., Nakahara, S., Tzou, W. S., Burkhardt, J. D., Dickfeld, T., Weiss, J. P., Bunch, J., Callans, D., Lakkireddy, D., Natale, A., ... Tholakanahalli, V. N. (2017). Ventricular Tachycardia Ablation in the Elderly: An International Ventricular Tachycardia Center Collaborative Group Analysis. Circulation: Arrhythmia and Electrophysiology, 10(12), [e005332]. https://doi.org/10.1161/CIRCEP.117.005332

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

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title = "Ventricular Tachycardia Ablation in the Elderly: An International Ventricular Tachycardia Center Collaborative Group Analysis",

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.",

keywords = "Aged, catheter ablation, heart failure, tachycardia, ventricular, ventricular fibrillation",

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.}",

note = "Funding Information: Dr Vakil has received an investigator initiated research grant from Medtronic Inc. Dr Garcia is a consultant for Surmodics and Osprey Medical. Dr Garcia is a recipient of a career development award (1IK2CX000699-01) from the VA Office of Research and Development and a research grant from Minnesota Veterans Research Foundation. Dr Di Biase is a consultant for Biosense Webster, St. Jude Medical, and Hansen Medical. Dr Nagashima has a fellowship with Medtronic Japan. Dr Tedrow receives honoraria from Medtronic, Boston Scientific, St. Jude Medical, and research grants from Biosense Webster and St Jude Medical. Dr Burkhardt is a consultant for Biosense Webster. Dr Tholakanahalli has received grants from the St Jude Medical foundation and Boston Scientific, research studies for Medtronic, Biotronik, Boston Scientific, and St. Jude Medical and holds patents with PATVJA One LLC. Dr Dickfeld has received a research grant from Biosense Webster and is a consultant for Biosense. Dr Weiss is a consultant for Stereotaxis. Dr Stevenson holds the patent for needle ablation consigned to Brigham and Women{\textquoteright}s Hospital. Dr Bella is a consultant for St. Jude Medical and receives honoraria for lectures from Biosense Webster, St Jude Medical, and Biotronik. The other authors report no conflicts. Publisher Copyright: {\textcopyright} 2017 American Heart Association, Inc.",

year = "2017",

month = dec,

day = "1",

doi = "10.1161/CIRCEP.117.005332",

language = "English (US)",

volume = "10",

journal = "Circulation: Arrhythmia and Electrophysiology",

issn = "1941-3149",

publisher = "Lippincott Williams and Wilkins",

number = "12",

}

TY - JOUR

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.

N1 - Funding Information: Dr Vakil has received an investigator initiated research grant from Medtronic Inc. Dr Garcia is a consultant for Surmodics and Osprey Medical. Dr Garcia is a recipient of a career development award (1IK2CX000699-01) from the VA Office of Research and Development and a research grant from Minnesota Veterans Research Foundation. Dr Di Biase is a consultant for Biosense Webster, St. Jude Medical, and Hansen Medical. Dr Nagashima has a fellowship with Medtronic Japan. Dr Tedrow receives honoraria from Medtronic, Boston Scientific, St. Jude Medical, and research grants from Biosense Webster and St Jude Medical. Dr Burkhardt is a consultant for Biosense Webster. Dr Tholakanahalli has received grants from the St Jude Medical foundation and Boston Scientific, research studies for Medtronic, Biotronik, Boston Scientific, and St. Jude Medical and holds patents with PATVJA One LLC. Dr Dickfeld has received a research grant from Biosense Webster and is a consultant for Biosense. Dr Weiss is a consultant for Stereotaxis. Dr Stevenson holds the patent for needle ablation consigned to Brigham and Women’s Hospital. Dr Bella is a consultant for St. Jude Medical and receives honoraria for lectures from Biosense Webster, St Jude Medical, and Biotronik. The other authors report no conflicts. Publisher Copyright: © 2017 American Heart Association, Inc.

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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U2 - 10.1161/CIRCEP.117.005332

DO - 10.1161/CIRCEP.117.005332

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AN - SCOPUS:85038641423

SN - 1941-3149

VL - 10

JO - Circulation: Arrhythmia and Electrophysiology

JF - Circulation: Arrhythmia and Electrophysiology

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M1 - e005332

ER -

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

Abstract

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