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Early Mortality After Catheter Ablation of Ventricular Tachycardia in Patients With Structural Heart Disease.

Abstract：

BACKGROUND:In patients referred for radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) in the setting of structural heart disease, early post-procedural mortality (EM) has not been previously investigated. OBJECTIVES:The purpose of this study was to evaluate EM after catheter ablation of scar-related VT. METHODS:Associations between clinical and procedural variables and EM (within 31 days of the procedure) were tested in patients with structural heart disease undergoing RFCA of VT at 12 international centers. RESULTS:Of 2,061 patients (mean age 62 ± 13 years; left ventricular ejection fraction [LVEF] 34 ± 13%; 53% ischemic etiology), EM occurred in 100 (5%; 95% confidence interval [CI]: 4% to 6%). A total of 54 (3%) patients died before hospital discharge (median 9 days after the procedure; 25% for refractory VT), including 12 (0.6%) after a major procedure-related complication. In multivariable analysis, the following factors were found to be significantly associated with EM: LVEF (odds ratio [OR] per percent decrease: 1.12; 95% CI: 1.05 to 1.20; p < 0.001), chronic kidney disease (OR: 2.73; 95% CI: 1.10 to 6.80; p = 0.030), presentation with VT storm (OR: 3.61; 95% CI: 1.37 to 9.48; p = 0.009), and presence of unmappable VTs (OR: 5.69; 95% CI: 1.37 to 23.69; p = 0.017). Recurrent VT was also associated with an increased risk of subsequent death (hazard ratio: 7.19; 95% CI: 5.57 to 9.28; p < 0.001) and EM (hazard ratio: 11.45; 95% CI: 7.47 to 17.59; p < 0.001). CONCLUSIONS:In a contemporary cohort of patients with scar-related VT undergoing RFCA, EM occurred in 5% of cases. Clinical and procedural variables indicating poorer clinical status (low LVEF, chronic kidney disease, VT storm, and unmappable VTs) and post-procedural VT recurrence may predict EM. Identification of such features may prompt early consideration for hemodynamic support or other care to help mitigate later potential complications.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Santangeli P,Frankel DS,Tung R,Vaseghi M,Sauer WH,Tzou WS,Mathuria N,Nakahara S,Dickfeldt TM,Lakkireddy D,Bunch TJ,Di Biase L,Natale A,Tholakanahalli V,Tedrow UB,Kumar S,Stevenson WG,Della Bella P,Shivkumar K,Marchl

doi

10.1016/j.jacc.2017.02.044

subject

Has Abstract

pub_date

2017-05-02 00:00:00

pages

2105-2115

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(17)30804-5

journal_volume

pub_type

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Early Mortality After Catheter Ablation of Ventricular Tachycardia in Patients With Structural Heart Disease.