Abstract:
BACKGROUND:Acute end points of catheter ablation for ventricular tachycardia (VT) remain incompletely defined. The aim of this study is to identify causes for failure in patients with structural heart disease and to assess the relation of this acute outcome to longer-term management and outcomes. METHODS AND RESULTS:From 2002 to 2010, 518 consecutive patients (84% male, 62 ± 14 years) with structural heart disease underwent a first ablation procedure for sustained VT at our institution. Acute ablation failure was defined as persistent inducibility of a clinical VT. Acute ablation failure was seen in 52 (10%) patients. Causes for failure were: intramural free wall VT in 13 (25%), deep septal VT in 9 (17%), decision not to ablate due to proximity to the bundle of His, left phrenic nerve, or a coronary artery in 3 (6%), and endocardial ablation failure with inability or decision not to attempt to access the epicardium in 27 (52%) patients. In multivariable analysis, ablation failure was an independent predictor of mortality (hazard ratio 2.010, 95% CI 1.147 to 3.239, P=0.004) and VT recurrence (hazard ratio 2.385, 95% CI 1.642 to 3.466, P<0.001). CONCLUSIONS:With endocardial or epicardial ablation, or both, acute ablation failure was seen in 10% of patients, largely due to anatomic factors. Persistence of a clinical VT is associated with recurrence and comparatively higher mortality.
journal_name
J Am Heart Assocjournal_title
Journal of the American Heart Associationauthors
Tokuda M,Kojodjojo P,Tung S,Tedrow UB,Nof E,Inada K,Koplan BA,Michaud GF,John RM,Epstein LM,Stevenson WGdoi
10.1161/JAHA.113.000072subject
Has Abstractpub_date
2013-05-31 00:00:00pages
e000072issue
3issn
2047-9980pii
2/3/e000072journal_volume
2pub_type
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