Wendy S Tzou1, Roderick Tung2, David S Frankel3, Luigi Di Biase4, Pasquale Santangeli2, Marmar Vaseghi5, T Jared Bunch6, J Peter Weiss6, Venkatakrishna N Tholakanahalli7, Dhanunjaya Lakkireddy8, Rama Vunnam9, Timm Dickfeld9, Nilesh Mathuria10, Usha Tedrow11, Pasquale Vergara12, Kairav Vakil7, Shiro Nakahara13, J David Burkhardt14, William G Stevenson11, David J Callans3, Paolo Della Bella12, Andrea Natale14, Kalyanam Shivkumar5, Francis E Marchlinski3, William H Sauer15. 1. University of Colorado Health System, Aurora, Colorado. Electronic address: wendy.tzou@ucdenver.edu. 2. University of Chicago Medical Center, Chicago, Illinois. 3. Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. 4. Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas. 5. UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California. 6. Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah. 7. University of Minnesota Medical Center, Minneapolis VA Medical Center, Minneapolis, Minnesota. 8. University of Kansas Medical Center, Kansas City, Kansas. 9. University of Maryland Medical Center, Baltimore, Maryland. 10. Baylor St. Luke's Medical Center/Texas Heart Institute, Houston, Texas. 11. Brigham and Women's Hospital, Boston, Massachusetts. 12. Hospital San Raffaele, Milan, Italy. 13. Dokkyo Medical University Koshigaya Hospital, Saitama, Japan. 14. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas. 15. University of Colorado Health System, Aurora, Colorado.
Abstract
BACKGROUND: Data evaluating repeat radiofrequency ablation (>1RFA) of ventricular tachycardia (VT) are limited. OBJECTIVE: The purpose of this study was to determine the safety and outcomes of VT >1RFA in patients with structural heart disease. METHODS: Patients with structural heart disease undergoing VT RFA at 12 centers with data on prior RFA history were included. Characteristics and outcomes were compared between first-time (1RFA) and >1RFA patients. RESULTS: Of 1990 patients, 740 had >1RFA (mean 1.4 ± 0.9, range 1-10). >1RFA vs 1RFA patients did not differ with regard to age (62 ± 13 years vs 62 ± 13 years), left ventricular ejection fraction (33% ± 13% vs 34% ± 13%), or sex (88% vs 87% men), but they more often were nonischemic (53% vs 41%), had implantable cardioverter-defibrillator shocks (70% vs 63%) or VT storm (38% vs 33%), and had been treated with amiodarone (55% vs 48%) or ≥2 antiarrhythmic drugs (22% vs 14%). >1RFA procedures were longer (300 ± 122 minutes vs 266 ± 110 minutes), involved more epicardial access (41% vs 21%), induced VTs (2.4 ± 2.2 vs 1.9 ± 1.6) and only unmappable VTs (15% vs 9%), and VT was more often inducible after RFA (42% vs 33%, all P <.03). Total complications were higher for >1RFA vs 1RFA (8% vs 5%, P <.01), mostly related to pericardial effusion (2.4% vs 1.3%, P = .07) and venous thrombosis (0.8% vs 0.2%, P = .06). VT recurrence was higher for >1RFA vs 1RFA (29% vs 24%, P <.001). Survival was worse for >1RFA vs 1RFA if VT recurred (67% vs 78%, P = .003) but was equivalent if successful (93% vs 92%, P = .96). CONCLUSION: Patients requiring repeat VT ablation differ significantly from those undergoing first-time ablation. Despite more challenging ablation characteristics, VT-free survival after repeat ablations is encouraging. Mortality is comparable if VT does not recur after RFA at specialized centers.
BACKGROUND: Data evaluating repeat radiofrequency ablation (>1RFA) of ventricular tachycardia (VT) are limited. OBJECTIVE: The purpose of this study was to determine the safety and outcomes of VT >1RFA in patients with structural heart disease. METHODS:Patients with structural heart disease undergoing VT RFA at 12 centers with data on prior RFA history were included. Characteristics and outcomes were compared between first-time (1RFA) and >1RFA patients. RESULTS: Of 1990 patients, 740 had >1RFA (mean 1.4 ± 0.9, range 1-10). >1RFA vs 1RFA patients did not differ with regard to age (62 ± 13 years vs 62 ± 13 years), left ventricular ejection fraction (33% ± 13% vs 34% ± 13%), or sex (88% vs 87% men), but they more often were nonischemic (53% vs 41%), had implantable cardioverter-defibrillator shocks (70% vs 63%) or VT storm (38% vs 33%), and had been treated with amiodarone (55% vs 48%) or ≥2 antiarrhythmic drugs (22% vs 14%). >1RFA procedures were longer (300 ± 122 minutes vs 266 ± 110 minutes), involved more epicardial access (41% vs 21%), induced VTs (2.4 ± 2.2 vs 1.9 ± 1.6) and only unmappable VTs (15% vs 9%), and VT was more often inducible after RFA (42% vs 33%, all P <.03). Total complications were higher for >1RFA vs 1RFA (8% vs 5%, P <.01), mostly related to pericardial effusion (2.4% vs 1.3%, P = .07) and venous thrombosis (0.8% vs 0.2%, P = .06). VT recurrence was higher for >1RFA vs 1RFA (29% vs 24%, P <.001). Survival was worse for >1RFA vs 1RFA if VT recurred (67% vs 78%, P = .003) but was equivalent if successful (93% vs 92%, P = .96). CONCLUSION:Patients requiring repeat VT ablation differ significantly from those undergoing first-time ablation. Despite more challenging ablation characteristics, VT-free survival after repeat ablations is encouraging. Mortality is comparable if VT does not recur after RFA at specialized centers.
Authors: Pasquale Vergara; Wendy S Tzou; Roderick Tung; Chiara Brombin; Alessandro Nonis; Marmar Vaseghi; David S Frankel; Luigi Di Biase; Usha Tedrow; Nilesh Mathuria; Shiro Nakahara; Venkat Tholakanahalli; T Jared Bunch; J Peter Weiss; Timm Dickfeld; Dhanunjaya Lakireddy; J David Burkhardt; Pasquale Santangeli; David Callans; Andrea Natale; Francis Marchlinski; William G Stevenson; Kalyanam Shivkumar; William H Sauer; Paolo Della Bella Journal: Circ Arrhythm Electrophysiol Date: 2018-12
Authors: Yang Chen; Manuel Gomes; Jason V Garcia; Ross J Hunter; Anthony W Chow; Mehul Dhinoja; Richard J Schilling; Martin Lowe; Pier D Lambiase Journal: Open Heart Date: 2020-01-28
Authors: Megan Kunkel; Peter Rothstein; Peter Sauer; Matthew M Zipse; Amneet Sandhu; Alexis Z Tumolo; Ryan T Borne; Ryan G Aleong; Joseph C Cleveland; David Fullerton; Jay D Pal; Austin S Davies; Curtis Lane; Duy T Nguyen; William H Sauer; Wendy S Tzou Journal: Heart Rhythm O2 Date: 2021-05-11