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Outcomes after repeat ablation of ventricular tachycardia in structural heart disease: An analysis from the International VT Ablation Center Collaborative Group.

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.

journal_name

Heart Rhythm

journal_title

Heart rhythm

authors

Tzou WS,Tung R,Frankel DS,Di Biase L,Santangeli P,Vaseghi M,Bunch TJ,Weiss JP,Tholakanahalli VN,Lakkireddy D,Vunnam R,Dickfeld T,Mathuria N,Tedrow U,Vergara P,Vakil K,Nakahara S,Burkhardt JD,Stevenson WG,Callans DJ

doi

10.1016/j.hrthm.2017.03.008

subject

Has Abstract

pub_date

2017-07-01 00:00:00

pages

991-997

issue

7

eissn

1547-5271

issn

1556-3871

pii

S1547-5271(17)30301-6

journal_volume

14

pub_type

杂志文章

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