Konstantinos C Siontis1, Hyungjin Myra Kim1, William G Stevenson1, Akira Fujii1, Paolo Della Bella1, Pasquale Vergara1, Kalyanam Shivkumar1, Roderick Tung1, Duc H Do1, Emile G Daoud1, Toshimasa Okabe1, Katja Zeppenfeld1, Marta de Riva Silva1, Gerhard Hindricks1, Arash Arya1, Alexander Weber1, Karl-Heinz Kuck1, Andreas Metzner1, Shibu Mathew1, Johannes Riedl1, Miki Yokokawa1, Krit Jongnarangsin1, Rakesh Latchamsetty1, Fred Morady1, Frank M Bogun2. 1. From the Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (K.C.S., H.M.K., M.Y., K.J., R.L., F.M., F.M.B.); Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (W.G.S., A.F.); Arrhythmia Unit, San Raffaele University Hospital, Milan, Italy (P.D.B., P.V.); Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., D.H.D.); Center for Heart Rhythm, University of Chicago, IL (R.T.); Electrophysiology Section, Division of Cardiology, Ohio State University, Columbus (E.G.D., T.O.); Department of Cardiology, Leiden University Medical Center, The Netherlands (K.Z., M.d.R.S.); Division of Cardiology, University Hospital, Leipzig, Germany (G.H., A.A., A.W.); and Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M., S.M., J.R.). 2. From the Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (K.C.S., H.M.K., M.Y., K.J., R.L., F.M., F.M.B.); Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (W.G.S., A.F.); Arrhythmia Unit, San Raffaele University Hospital, Milan, Italy (P.D.B., P.V.); Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., D.H.D.); Center for Heart Rhythm, University of Chicago, IL (R.T.); Electrophysiology Section, Division of Cardiology, Ohio State University, Columbus (E.G.D., T.O.); Department of Cardiology, Leiden University Medical Center, The Netherlands (K.Z., M.d.R.S.); Division of Cardiology, University Hospital, Leipzig, Germany (G.H., A.A., A.W.); and Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M., S.M., J.R.). fbogun@med.umich.edu.
Abstract
BACKGROUND: Recurrence of ventricular tachycardia (VT) after ablation in patients with previous myocardial infarction is associated with adverse prognosis. However, the impact of the timing of VT recurrence on outcomes is unclear. METHODS AND RESULTS: We analyzed data from a multicenter collaborative database of patients who underwent catheter ablation for infarct-related VT. Multivariable Cox regression analyses investigated the effect of the timing of VT recurrence on the composite outcome of death or heart transplantation using VT recurrence as a time-varying covariate. A total of 1412 patients were included (92% men; age: 66.7±10.7 years), and 605 patients (42.8%) had a recurrence after median 116 days (188 [31.1%] within 1 month, 239 [39.5%] between 1 and 12 months, and 178 [29.4%] after 12 months). At median follow-up of 670 days, 375 patients (26.6%) experienced death or heart transplantation. The median time from recurrence to death or heart transplantation was 65 and 198.5 days in patients with recurrence ≤30 days and >30 days post ablation, respectively. The adjusted hazard ratio (95% confidence interval) for the effect of VT recurrence occurring immediately post ablation on death or heart transplantation was 3.45 (2.33-5.11) in reference to no recurrence. However, the magnitude of this effect decreased statistically significantly (P<0.001) as recurrence occurred later in the follow-up period. The respective risk estimates for VT recurrence at 30 days, 6 months, 1 year, and 2 years were 3.36 (2.29-4.93), 2.94 (2.09-4.14), 2.50 (1.85-3.37), and 1.81 (1.37-2.40). CONCLUSIONS: VT recurrence post ablation is associated with a mortality risk that is highest soon after the ablation and decreases gradually thereafter.
BACKGROUND: Recurrence of ventricular tachycardia (VT) after ablation in patients with previous myocardial infarction is associated with adverse prognosis. However, the impact of the timing of VT recurrence on outcomes is unclear. METHODS AND RESULTS: We analyzed data from a multicenter collaborative database of patients who underwent catheter ablation for infarct-related VT. Multivariable Cox regression analyses investigated the effect of the timing of VT recurrence on the composite outcome of death or heart transplantation using VT recurrence as a time-varying covariate. A total of 1412 patients were included (92% men; age: 66.7±10.7 years), and 605 patients (42.8%) had a recurrence after median 116 days (188 [31.1%] within 1 month, 239 [39.5%] between 1 and 12 months, and 178 [29.4%] after 12 months). At median follow-up of 670 days, 375 patients (26.6%) experienced death or heart transplantation. The median time from recurrence to death or heart transplantation was 65 and 198.5 days in patients with recurrence ≤30 days and >30 days post ablation, respectively. The adjusted hazard ratio (95% confidence interval) for the effect of VT recurrence occurring immediately post ablation on death or heart transplantation was 3.45 (2.33-5.11) in reference to no recurrence. However, the magnitude of this effect decreased statistically significantly (P<0.001) as recurrence occurred later in the follow-up period. The respective risk estimates for VT recurrence at 30 days, 6 months, 1 year, and 2 years were 3.36 (2.29-4.93), 2.94 (2.09-4.14), 2.50 (1.85-3.37), and 1.81 (1.37-2.40). CONCLUSIONS:VT recurrence post ablation is associated with a mortality risk that is highest soon after the ablation and decreases gradually thereafter.
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