BACKGROUND: Ventricular arrhythmias in patients with implantable cardioverter-defibrillators (ICDs) adversely affect outcomes. Antiarrhythmic approaches to ventricular tachycardia (VT) have variable efficacy and may increase risk of ventricular arrhythmias, worsening cardiomyopathy, and death. Comparatively, VT ablation is an alternative approach that may favorably affect outcomes. OBJECTIVE: To further explore the effect on long-term outcomes after catheter ablation of VT, we compared patients with history of ICD shocks who did not undergo ablation, patients with a history of ICD shocks that underwent ablation, and patients with ICDs who had no history of ICD shocks. METHODS: A total of 102 consecutive patients with structural heart disease who underwent VT ablation for recurrent ICD shocks were compared with 2088 patients with ICDs and no history of appropriate shocks and 817 patients with ICDs and a history of appropriate shocks for VT or ventricular fibrillation. Outcomes considered were mortality, heart failure hospitalization, atrial fibrillation, and stroke/transient ischemic attack. RESULTS: The mean age of 3007 patients was 65.4 ± 13.9 years. Over long-term follow-up, 866 (28.8%) died, 681 (22.7%) had a heart failure admission, 706 (23.5%) developed new-onset atrial fibrillation, and 224 (7.5%) had a stroke. The multivariate-adjusted risks of deaths and heart failure hospitalizations were higher in patients with history of ICD shocks who were treated medically than in patients with ICDs and no history of shock (hazard ratio [HR] 1.45; P < .0001 vs HR 2.00; P < .0001, respectively). The multivariate-adjusted risks were attenuated after VT ablation with death and heart failure hospitalization rates similar to those of patients with no shock (HR 0.89; P = .58 vs HR 1.38; P = .09, respectively). A similar nonsignificant trend was seen with stroke/transient ischemic attack. CONCLUSIONS: Patients treated with VT ablation after an ICD shock have a significantly lower risk of death and heart failure hospitalization than did patients managed medically only. The adverse event rates after VT ablation were similar to those of patients with ICDs but without VT.
BACKGROUND:Ventricular arrhythmias in patients with implantable cardioverter-defibrillators (ICDs) adversely affect outcomes. Antiarrhythmic approaches to ventricular tachycardia (VT) have variable efficacy and may increase risk of ventricular arrhythmias, worsening cardiomyopathy, and death. Comparatively, VT ablation is an alternative approach that may favorably affect outcomes. OBJECTIVE: To further explore the effect on long-term outcomes after catheter ablation of VT, we compared patients with history of ICD shocks who did not undergo ablation, patients with a history of ICD shocks that underwent ablation, and patients with ICDs who had no history of ICD shocks. METHODS: A total of 102 consecutive patients with structural heart disease who underwent VT ablation for recurrent ICD shocks were compared with 2088 patients with ICDs and no history of appropriate shocks and 817 patients with ICDs and a history of appropriate shocks for VT or ventricular fibrillation. Outcomes considered were mortality, heart failure hospitalization, atrial fibrillation, and stroke/transient ischemic attack. RESULTS: The mean age of 3007 patients was 65.4 ± 13.9 years. Over long-term follow-up, 866 (28.8%) died, 681 (22.7%) had a heart failure admission, 706 (23.5%) developed new-onset atrial fibrillation, and 224 (7.5%) had a stroke. The multivariate-adjusted risks of deaths and heart failure hospitalizations were higher in patients with history of ICD shocks who were treated medically than in patients with ICDs and no history of shock (hazard ratio [HR] 1.45; P < .0001 vs HR 2.00; P < .0001, respectively). The multivariate-adjusted risks were attenuated after VT ablation with death and heart failure hospitalization rates similar to those of patients with no shock (HR 0.89; P = .58 vs HR 1.38; P = .09, respectively). A similar nonsignificant trend was seen with stroke/transient ischemic attack. CONCLUSIONS:Patients treated with VT ablation after an ICD shock have a significantly lower risk of death and heart failure hospitalization than did patients managed medically only. The adverse event rates after VT ablation were similar to those of patients with ICDs but without VT.
Authors: 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 Tholakanahalli; Anastasios 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 Journal: Heart Rhythm Date: 2015-05-30 Impact factor: 6.343
Authors: Divyang Patel; Vic Hasselblad; Kevin P Jackson; Sean D Pokorney; James P Daubert; Sana M Al-Khatib Journal: J Interv Card Electrophysiol Date: 2015-12-22 Impact factor: 1.900
Authors: Anja Schade; Karin Nentwich; Patrick Müller; Joachim Krug; Sebastian Kerber; Thomas Deneke Journal: Herzschrittmacherther Elektrophysiol Date: 2014-06