Mohit K Turagam1, Venkat Vuddanda2, Donita Atkins2, Pasquale Santangeli3, David S Frankel3, Roderick Tung4, Marmar Vaseghi5, William H Sauer6, Wendy Tzou6, Nilesh Mathuria7, Shiro Nakahara8, Timm M Dickfeld9, T Jared Bunch10, Peter Weiss10, Luigi Di Biase11, Venkat Tholakanahalli12, Kairav Vakil12, Usha B Tedrow13, William G Stevenson13, Paolo Della Bella14, Kalyanam Shivkumar5, Francis E Marchlinski3, David J Callans3, Andrea Natale15, Madhu Reddy2, Dhanunjaya Lakkireddy16. 1. Division of Cardiovascular Medicine, University of Missouri Hospital and Clinics, Columbia, Missouri. 2. Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas. 3. Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. 4. Pritzker School of Medicine, University of Chicago Medicine, Chicago, Illinois. 5. UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California. 6. University of Colorado, Aurora, Colorado. 7. St. Luke's Health System/Texas Heart Institute and University of Texas Health Science Center, Houston, Texas. 8. Dokkyo Medical University Koshigaya Hospital, Saitama, Japan. 9. University of Maryland Medical Center, Baltimore, Maryland. 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. University of Minnesota Medical Center, Minneapolis VA Medical Center, Minneapolis, Minnesota. 13. Brigham and Women's Hospital, Boston, Massachusetts. 14. Hospital San Raffaele, Milan, Italy. 15. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas. 16. Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas. Electronic address: dlakkireddy@kumc.edu.
Abstract
OBJECTIVES: This study sought to evaluate the clinical outcomes of patients receiving hemodynamic support (HS) during ventricular tacchycardia (VT) ablation. BACKGROUND: There are limited real-world data evaluating its effect of HS in ablation outcomes. METHODS: An analysis of 1,655 patients from the International VT Ablation Center Collaborative group was performed. A total of 105 patients received HS with percutaneous ventricular assist device. RESULTS: Patients in the HS group had lower left ventricular ejection fraction (LVEF), higher New York Heart Association (NYHA) functional class, and more implantable cardioverter-defibrillator (ICD) shocks, VT storm, and antiarrhythmic drug use (all p < 0.05). The HS group also required significantly longer fluoroscopy, procedure, and total lesion time. Acute procedural success (71.8% vs. 73.7%; p = 0.04) was significantly lower and complications (12.5% vs. 6.5%; p = 0.03) and 1-year mortality (34.7% vs. 9.3%; p < 0.001) were significantly higher in the HS group. Multivariate Cox regression analysis demonstrated HS as an independent predictor of mortality (hazard ratio: 5.01; 95% confidence interval: 3.44 to 7.20; p < 0.001). There was no significant difference in VT recurrence between groups. In a subgroup analysis including LVEF ≤20% and NYHA functional class III to IV patients, acute procedural success (74.0% vs. 70.5%; p = 0.8), complications (15.6% vs. 7.8%; p = 0.2), VT recurrence (30.2% vs. 38.1%; p = 0.44), and 1-year mortality (40.0% vs. 28.8%; p = 0.2) were no different between the HS and no-HS groups. CONCLUSIONS: Patients requiring HS were sicker with multiple comorbidities and, as expected, had a significantly higher 1-year mortality than did those patients in the no-HS group. In patients with LVEF ≤20% and NYHA functional class III to IV, there was also no significant difference in clinical outcomes when compared with no HS. Further studies are needed to systematically evaluate patients undergoing VT ablation receiving HS.
OBJECTIVES: This study sought to evaluate the clinical outcomes of patients receiving hemodynamic support (HS) during ventricular tacchycardia (VT) ablation. BACKGROUND: There are limited real-world data evaluating its effect of HS in ablation outcomes. METHODS: An analysis of 1,655 patients from the International VT Ablation Center Collaborative group was performed. A total of 105 patients received HS with percutaneous ventricular assist device. RESULTS:Patients in the HS group had lower left ventricular ejection fraction (LVEF), higher New York Heart Association (NYHA) functional class, and more implantable cardioverter-defibrillator (ICD) shocks, VT storm, and antiarrhythmic drug use (all p < 0.05). The HS group also required significantly longer fluoroscopy, procedure, and total lesion time. Acute procedural success (71.8% vs. 73.7%; p = 0.04) was significantly lower and complications (12.5% vs. 6.5%; p = 0.03) and 1-year mortality (34.7% vs. 9.3%; p < 0.001) were significantly higher in the HS group. Multivariate Cox regression analysis demonstrated HS as an independent predictor of mortality (hazard ratio: 5.01; 95% confidence interval: 3.44 to 7.20; p < 0.001). There was no significant difference in VT recurrence between groups. In a subgroup analysis including LVEF ≤20% and NYHA functional class III to IV patients, acute procedural success (74.0% vs. 70.5%; p = 0.8), complications (15.6% vs. 7.8%; p = 0.2), VT recurrence (30.2% vs. 38.1%; p = 0.44), and 1-year mortality (40.0% vs. 28.8%; p = 0.2) were no different between the HS and no-HS groups. CONCLUSIONS:Patients requiring HS were sicker with multiple comorbidities and, as expected, had a significantly higher 1-year mortality than did those patients in the no-HS group. In patients with LVEF ≤20% and NYHA functional class III to IV, there was also no significant difference in clinical outcomes when compared with no HS. Further studies are needed to systematically evaluate patients undergoing VT ablation receiving HS.
Authors: Edmond M Cronin; Frank M Bogun; Philippe Maury; Petr Peichl; Minglong Chen; Narayanan Namboodiri; Luis Aguinaga; Luiz Roberto Leite; Sana M Al-Khatib; Elad Anter; Antonio Berruezo; David J Callans; Mina K Chung; Phillip Cuculich; Andre d'Avila; Barbara J Deal; Paolo Della Bella; Thomas Deneke; Timm-Michael Dickfeld; Claudio Hadid; Haris M Haqqani; G Neal Kay; Rakesh Latchamsetty; Francis Marchlinski; John M Miller; Akihiko Nogami; Akash R Patel; Rajeev Kumar Pathak; Luis C Saenz Morales; Pasquale Santangeli; John L Sapp; Andrea Sarkozy; Kyoko Soejima; William G Stevenson; Usha B Tedrow; Wendy S Tzou; Niraj Varma; Katja Zeppenfeld Journal: J Interv Card Electrophysiol Date: 2020-10 Impact factor: 1.900
Authors: Edmond M Cronin; Frank M Bogun; Philippe Maury; Petr Peichl; Minglong Chen; Narayanan Namboodiri; Luis Aguinaga; Luiz Roberto Leite; Sana M Al-Khatib; Elad Anter; Antonio Berruezo; David J Callans; Mina K Chung; Phillip Cuculich; Andre d'Avila; Barbara J Deal; Paolo Della Bella; Thomas Deneke; Timm-Michael Dickfeld; Claudio Hadid; Haris M Haqqani; G Neal Kay; Rakesh Latchamsetty; Francis Marchlinski; John M Miller; Akihiko Nogami; Akash R Patel; Rajeev Kumar Pathak; Luis C Sáenz Morales; Pasquale Santangeli; John L Sapp; Andrea Sarkozy; Kyoko Soejima; William G Stevenson; Usha B Tedrow; Wendy S Tzou; Niraj Varma; Katja Zeppenfeld Journal: Europace Date: 2019-08-01 Impact factor: 5.214
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