Martin Aguilar1,2, Usha B Tedrow1,2, Wendy S Tzou3, Roderick Tung4, David S Frankel5, Pasquale Santangeli5, Marmar Vaseghi6, T Jared Bunch7, Luigi Di Biase8, Venkatakrishna N Tholakanahalli9, Dhanunjaya Lakkireddy10, Timm Dickfeld11, J Peter Weiss12, Nilesh Mathuria13, Pasquale Vergara14, Shiro Nakahara6, Jason S Bradfield6, J David Burkhardt15, William G Stevenson16, David J Callans5, Paolo Della Bella17, Andrea Natale15, Kalyanam Shivkumar6, Francis E Marchlinski5, William H Sauer1,2. 1. Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. 2. Department of Medicine, Harvard Medical School, Boston, MA, USA. 3. Division of Cardiovascular Medicine, Cardiac Electrophysiology, University of Colorado School of Medicine, Aurora, Colorado, USA. 4. Division of Cardiovascular Medicine, Center for Arrhythmia Care, University of Chicago, Chicago, Illinois, USA. 5. Division of Cardiovascular Medicine, Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA. 6. Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. 7. Cardiovascular Medicine Division, University of Utah School of Medicine, Salt Lake City, Utah, USA. 8. Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA. 9. Division of Cardiology, VA Medical Center, Minneapolis, MN & University of Minnesot, Department of Medicine, Minneapolis, Minnesota, USA. 10. The Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA. 11. Division of Cardiology, Baltimore VA Medical Center, Baltimore, Maryland, USA. 12. Cardiac Electrophysiology, Banner - University Medicine Heart Institute, Phoenix, Arizona, USA. 13. Department of Medicine, Baylor College of Medicine, Houston, Texas, USA. 14. Arrhythmia Unit and Electrophysiology Laboratories, Milano, Italy. 15. St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas, USA. 16. Department of Medicine, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee, USA. 17. Arrhythmia Unit, San Raffaele Hospital, Milan, Italy.
Abstract
INTRODUCTION: Patients with prior cardiac surgery may represent a subgroup of patients with ventricular tachycardia (VT) that may be more difficult to control with catheter ablation. METHODS: We evaluated 1901 patients with ischemic and nonischemic cardiomyopathy who underwent VT ablation at 12 centers. Clinical characteristics and VT radiofrequency ablation procedural outcomes were assessed and compared between those with and without prior cardiac surgery. Kaplan-Meier analysis was used to estimate freedom from recurrent VT and survival. RESULTS: There were 578 subjects (30.4%) with prior cardiac surgery identified in the cohort. Those with prior cardiac surgery were older (66.4 ± 11.0 years vs. 60.5 ± 13.9 years, p < .01), with lower left ventricular ejection fraction (30.2 ± 11.5% vs. 34.8 ± 13.6%, p < .01) and more ischemic heart disease (82.5% vs. 39.3%, p < .01) but less likely to undergo epicardial mapping or ablation (9.0% vs. 38.1%, p<.01) compared to those without prior surgery. When epicardial mapping was performed, a significantly greater proportion required surgical intervention for access (19/52 [36.5%] vs. 14/504 [2.8%]; p < .01). Procedural complications, including epicardial access-related complications, were lower (5.7% vs. 7.0%, p < .01) in patients with versus without prior cardiac surgery. VT-free survival (75.1% vs. 74.1%, p = .805) and survival (86.5% vs. 87.9%, p = .397) were not different between those with and without prior heart surgery, regardless of etiology of cardiomyopathy. VT recurrence was associated with increased mortality in patients with and without prior cardiac surgery. CONCLUSION: Despite different clinical characteristics and fewer epicardial procedures, the safety and efficacy of VT ablation in patients with prior cardiac surgery is similar to others in this cohort. The incremental yield of epicardial mapping in predominant ischemic cardiomyopathy population prior heart surgery may be low but appears safe in experienced centers.
INTRODUCTION:Patients with prior cardiac surgery may represent a subgroup of patients with ventricular tachycardia (VT) that may be more difficult to control with catheter ablation. METHODS: We evaluated 1901 patients with ischemic and nonischemic cardiomyopathy who underwent VT ablation at 12 centers. Clinical characteristics and VT radiofrequency ablation procedural outcomes were assessed and compared between those with and without prior cardiac surgery. Kaplan-Meier analysis was used to estimate freedom from recurrent VT and survival. RESULTS: There were 578 subjects (30.4%) with prior cardiac surgery identified in the cohort. Those with prior cardiac surgery were older (66.4 ± 11.0 years vs. 60.5 ± 13.9 years, p < .01), with lower left ventricular ejection fraction (30.2 ± 11.5% vs. 34.8 ± 13.6%, p < .01) and more ischemic heart disease (82.5% vs. 39.3%, p < .01) but less likely to undergo epicardial mapping or ablation (9.0% vs. 38.1%, p<.01) compared to those without prior surgery. When epicardial mapping was performed, a significantly greater proportion required surgical intervention for access (19/52 [36.5%] vs. 14/504 [2.8%]; p < .01). Procedural complications, including epicardial access-related complications, were lower (5.7% vs. 7.0%, p < .01) in patients with versus without prior cardiac surgery. VT-free survival (75.1% vs. 74.1%, p = .805) and survival (86.5% vs. 87.9%, p = .397) were not different between those with and without prior heart surgery, regardless of etiology of cardiomyopathy. VT recurrence was associated with increased mortality in patients with and without prior cardiac surgery. CONCLUSION: Despite different clinical characteristics and fewer epicardial procedures, the safety and efficacy of VT ablation in patients with prior cardiac surgery is similar to others in this cohort. The incremental yield of epicardial mapping in predominant ischemic cardiomyopathy population prior heart surgery may be low but appears safe in experienced centers.
Authors: Ahmadreza Karimianpour; Patrick Badertscher; Joshua Payne; Michael Field; Michael R Gold; Jeffrey R Winterfield Journal: J Interv Card Electrophysiol Date: 2022-05-18 Impact factor: 1.900