Jorge Romero1, Luigi Di Biase1, Juan Carlos Diaz1, Renato Quispe1, Xianfeng Du2, David Briceno1, Ricardo Avendano1, Usha Tedrow3, Roy M John4, Gregory F Michaud4, Andrea Natale1, William G Stevenson5, Saurabh Kumar6. 1. Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York. 2. Department of Cardiology, Ningbo First Hospital, Zhejiang Sheng, China. 3. Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts. 4. Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. 5. Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts; Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. 6. Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts; Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Westmead, New South Wales, Australia. Electronic address: saurabh.kumar@health.nsw.gov.au.
Abstract
OBJECTIVES: This was a meta-analysis of published studies to examine the impact of early referral on outcomes after catheter ablation for ventricular tachycardia (VT) in patients with structural heart disease. BACKGROUND: Patients are frequently referred for VT ablation after failure of antiarrhythmic drugs to control VT. Some studies have suggested that early referral might confer better outcomes. METHODS: An electronic search was performed using major databases. The primary outcomes were long-term VT recurrence and total mortality. Secondary outcomes were acute procedural success and acute complications. RESULTS: Three studies were included with a total of 980 patients (mean age 64 ± 12 years, 71% males). Mean follow-up was 29 ± 27 months. Early referral for VT ablation was associated with decreased VT recurrence and acute complications compared with late referral (relative risk: 0.69 [95% confidence interval: 0.58 to 0.82], p < 0.0001 and relative risk: 0.50 [95% confidence interval: 0.27 to 0.93], p = 0.03, respectively). There was no significant difference between early and late referral for total mortality and acute success. CONCLUSIONS: Late referral for VT ablation was associated with worse outcomes (VT recurrence and acute complications) in patients with structural heart disease, which suggests that early referral for VT ablation might be a reasonable consideration in this patient population.
OBJECTIVES: This was a meta-analysis of published studies to examine the impact of early referral on outcomes after catheter ablation for ventricular tachycardia (VT) in patients with structural heart disease. BACKGROUND:Patients are frequently referred for VT ablation after failure of antiarrhythmic drugs to control VT. Some studies have suggested that early referral might confer better outcomes. METHODS: An electronic search was performed using major databases. The primary outcomes were long-term VT recurrence and total mortality. Secondary outcomes were acute procedural success and acute complications. RESULTS: Three studies were included with a total of 980 patients (mean age 64 ± 12 years, 71% males). Mean follow-up was 29 ± 27 months. Early referral for VT ablation was associated with decreased VT recurrence and acute complications compared with late referral (relative risk: 0.69 [95% confidence interval: 0.58 to 0.82], p < 0.0001 and relative risk: 0.50 [95% confidence interval: 0.27 to 0.93], p = 0.03, respectively). There was no significant difference between early and late referral for total mortality and acute success. CONCLUSIONS: Late referral for VT ablation was associated with worse outcomes (VT recurrence and acute complications) in patients with structural heart disease, which suggests that early referral for VT ablation might be a reasonable consideration in this patient population.
Authors: Fa Po Chung; Chin Yu Lin; Yenn Jiang Lin; Shih Lin Chang; Li Wei Lo; Yu Feng Hu; Ta Chuan Tuan; Tze Fan Chao; Jo Nan Liao; Ting Yung Chang; Shih Ann Chen Journal: Korean Circ J Date: 2018-10 Impact factor: 3.243