Pasquale Santangeli1, David S Frankel2, Roderick Tung3, Marmar Vaseghi4, William H Sauer5, Wendy S Tzou5, Nilesh Mathuria6, Shiro Nakahara7, Timm M Dickfeldt8, Dhanunjaya Lakkireddy9, T Jared Bunch10, Luigi Di Biase11, Andrea Natale12, Venkat Tholakanahalli13, Usha B Tedrow14, Saurabh Kumar14, William G Stevenson14, Paolo Della Bella15, Kalyanam Shivkumar4, Francis E Marchlinski2, David J Callans2. 1. Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: pasquale.santangeli@uphs.upenn.edu. 2. Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. 3. University of Chicago Medicine, Pritzker School of Medicine, Chicago, Illinois. 4. UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California. 5. University of Colorado, Aurora, Colorado. 6. Baylor St. Luke's Medical Center/Texas Heart Institute, Houston, Texas. 7. Dokkyo Medical University Koshigaya Hospital, Saitama, Japan. 8. University of Maryland Medical Center, Baltimore, Maryland. 9. University of Kansas Medical Center, Kansas City, Kansas. 10. Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah. 11. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Albert Einstein College of Medicine at Montefiore Hospital, New York, New York. 12. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas. 13. University of Minnesota Medical Center, Minneapolis VA Medical Center, Minneapolis, Minnesota. 14. Brigham and Women's Hospital, Boston, Massachusetts. 15. Hospital San Raffaele, Milan, Italy.
Abstract
BACKGROUND: In patients referred for radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) in the setting of structural heart disease, early post-procedural mortality (EM) has not been previously investigated. OBJECTIVES: The purpose of this study was to evaluate EM after catheter ablation of scar-related VT. METHODS: Associations between clinical and procedural variables and EM (within 31 days of the procedure) were tested in patients with structural heart disease undergoing RFCA of VT at 12 international centers. RESULTS: Of 2,061 patients (mean age 62 ± 13 years; left ventricular ejection fraction [LVEF] 34 ± 13%; 53% ischemic etiology), EM occurred in 100 (5%; 95% confidence interval [CI]: 4% to 6%). A total of 54 (3%) patients died before hospital discharge (median 9 days after the procedure; 25% for refractory VT), including 12 (0.6%) after a major procedure-related complication. In multivariable analysis, the following factors were found to be significantly associated with EM: LVEF (odds ratio [OR] per percent decrease: 1.12; 95% CI: 1.05 to 1.20; p < 0.001), chronic kidney disease (OR: 2.73; 95% CI: 1.10 to 6.80; p = 0.030), presentation with VT storm (OR: 3.61; 95% CI: 1.37 to 9.48; p = 0.009), and presence of unmappable VTs (OR: 5.69; 95% CI: 1.37 to 23.69; p = 0.017). Recurrent VT was also associated with an increased risk of subsequent death (hazard ratio: 7.19; 95% CI: 5.57 to 9.28; p < 0.001) and EM (hazard ratio: 11.45; 95% CI: 7.47 to 17.59; p < 0.001). CONCLUSIONS: In a contemporary cohort of patients with scar-related VT undergoing RFCA, EM occurred in 5% of cases. Clinical and procedural variables indicating poorer clinical status (low LVEF, chronic kidney disease, VT storm, and unmappable VTs) and post-procedural VT recurrence may predict EM. Identification of such features may prompt early consideration for hemodynamic support or other care to help mitigate later potential complications.
BACKGROUND: In patients referred for radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) in the setting of structural heart disease, early post-procedural mortality (EM) has not been previously investigated. OBJECTIVES: The purpose of this study was to evaluate EM after catheter ablation of scar-related VT. METHODS: Associations between clinical and procedural variables and EM (within 31 days of the procedure) were tested in patients with structural heart disease undergoing RFCA of VT at 12 international centers. RESULTS: Of 2,061 patients (mean age 62 ± 13 years; left ventricular ejection fraction [LVEF] 34 ± 13%; 53% ischemic etiology), EM occurred in 100 (5%; 95% confidence interval [CI]: 4% to 6%). A total of 54 (3%) patients died before hospital discharge (median 9 days after the procedure; 25% for refractory VT), including 12 (0.6%) after a major procedure-related complication. In multivariable analysis, the following factors were found to be significantly associated with EM: LVEF (odds ratio [OR] per percent decrease: 1.12; 95% CI: 1.05 to 1.20; p < 0.001), chronic kidney disease (OR: 2.73; 95% CI: 1.10 to 6.80; p = 0.030), presentation with VT storm (OR: 3.61; 95% CI: 1.37 to 9.48; p = 0.009), and presence of unmappable VTs (OR: 5.69; 95% CI: 1.37 to 23.69; p = 0.017). Recurrent VT was also associated with an increased risk of subsequent death (hazard ratio: 7.19; 95% CI: 5.57 to 9.28; p < 0.001) and EM (hazard ratio: 11.45; 95% CI: 7.47 to 17.59; p < 0.001). CONCLUSIONS: In a contemporary cohort of patients with scar-related VT undergoing RFCA, EM occurred in 5% of cases. Clinical and procedural variables indicating poorer clinical status (low LVEF, chronic kidney disease, VT storm, and unmappable VTs) and post-procedural VT recurrence may predict EM. Identification of such features may prompt early consideration for hemodynamic support or other care to help mitigate later potential complications.
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