BACKGROUND: Catheter ablation for ventricular tachycardia (VT) from structural heart disease has a significant risk of recurrence, but the optimal duration for in-hospital monitoring is not defined. This study assesses the timing, correlates, and prognostic significance of early VT recurrence after ablation. METHODS AND RESULTS: Of 370 patients (313 men; aged 63.0±13.2 years) who underwent a first radiofrequency ablation for sustained monomorphic VT associated with structural heart disease from 2008 to 2012, sustained VT recurred in 81 patients (22%) within 7 days. In multivariable analysis, early recurrence was associated with New York Heart Association classification ≥III (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.03-3.48; P=0.04), dilated cardiomyopathy (OR 1.93, 95% CI 1.03-3.57; P=0.04), prevalence of VT storm before the procedure (OR 2.62, 95% CI 1.48-4.65; P=0.001), a greater number of induced VTs (OR 1.24, 95% CI 1.07-1.45; P=0.006), and acute failure or no final induction test (OR 1.88, 95% CI 1.03-3.40; P=0.04). During a median of 2.5 (1.2, 4.0) years of follow-up, early VT recurrence was an independent correlates of mortality (hazard ratio 2.59, 95% CI 1.52-4.34; P=0.0005). CONCLUSIONS: Patients who have early recurrences of VT after ablation are a high risk group who may be identifiable from their clinical profile. Further study is warranted to define the optimal treatment strategies for this patient group.
BACKGROUND: Catheter ablation for ventricular tachycardia (VT) from structural heart disease has a significant risk of recurrence, but the optimal duration for in-hospital monitoring is not defined. This study assesses the timing, correlates, and prognostic significance of early VT recurrence after ablation. METHODS AND RESULTS: Of 370 patients (313 men; aged 63.0±13.2 years) who underwent a first radiofrequency ablation for sustained monomorphic VT associated with structural heart disease from 2008 to 2012, sustained VT recurred in 81 patients (22%) within 7 days. In multivariable analysis, early recurrence was associated with New York Heart Association classification ≥III (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.03-3.48; P=0.04), dilated cardiomyopathy (OR 1.93, 95% CI 1.03-3.57; P=0.04), prevalence of VT storm before the procedure (OR 2.62, 95% CI 1.48-4.65; P=0.001), a greater number of induced VTs (OR 1.24, 95% CI 1.07-1.45; P=0.006), and acute failure or no final induction test (OR 1.88, 95% CI 1.03-3.40; P=0.04). During a median of 2.5 (1.2, 4.0) years of follow-up, early VT recurrence was an independent correlates of mortality (hazard ratio 2.59, 95% CI 1.52-4.34; P=0.0005). CONCLUSIONS:Patients who have early recurrences of VT after ablation are a high risk group who may be identifiable from their clinical profile. Further study is warranted to define the optimal treatment strategies for this patient group.
Authors: Konstantinos C Siontis; Hyungjin Myra Kim; William G Stevenson; Akira Fujii; Paolo Della Bella; Pasquale Vergara; Kalyanam Shivkumar; Roderick Tung; Duc H Do; Emile G Daoud; Toshimasa Okabe; Katja Zeppenfeld; Marta de Riva Silva; Gerhard Hindricks; Arash Arya; Alexander Weber; Karl-Heinz Kuck; Andreas Metzner; Shibu Mathew; Johannes Riedl; Miki Yokokawa; Krit Jongnarangsin; Rakesh Latchamsetty; Fred Morady; Frank M Bogun Journal: Circ Arrhythm Electrophysiol Date: 2016-12
Authors: Nishaki K Mehta; Christopher Schumann; Giovanni Davogustto; Andrew Cluckey; Evan Harmon; Joshua France; James M Mangrum; Pamela Mason; Sula Mazimba; Rohit Malhotra; Kenneth Bilchick; Andrew Darby; Michael Salerno; Christopher M Kramer; William Stevenson Journal: J Innov Card Rhythm Manag Date: 2022-03-15