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

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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.

Key Words

complications
heart failure
outcome assessment
radiofrequency ablation

Abbreviations and Acronyms

CABG
coronary artery bypass graft
CI
confidence interval
EM
early mortality
ICM
ischemic cardiomyopathy
LVEF
left ventricular ejection fraction
OR
odds ratio
PCI
percutaneous coronary intervention
RFCA
radiofrequency catheter ablation
VT
ventricular tachycardia

Cited by (0)

This trial was an unfunded, investigator-initiated collaborative study. Dr. Santangeli has received honoraria from Biosense Webster, Baylis Medical, Boston Scientific, and Medtronic; and is a consultant for Biosense Webster and Baylis Medical. Dr. Shivkumar is supported by National Heart, Lung, and Blood Institute grant R01HL084261. Dr. Tzou has received speaker honoraria from Boston Scientific. Dr. Di Biase is a consultant for Stereotaxis, Biosense Webster, and St. Jude Medical; and has received speaker honorarium/travel reimbursement from Biotronik, Medtronic, Boston Scientific, Janssen, Pfizer, and Epi EP. Dr. Natale is a consultant for Stereotaxis, Biosense Webster, and St. Jude Medical; and has received speaker honorarium/travel reimbursement from Biotronik, Medtronic, Boston Scientific, Janssen, Pfizer, and Epi EP. Dr. Tholakanahalli has received grants from St. Jude Medical Foundation. Dr. Tedrow has received honoraria from Medtronic, Boston Scientific, Biosense Webster, and St. Jude Medical; and research grants from Biosense Webster and St. Jude Medical. Dr. Burkhardt is a consultant to Biosense Webster. Dr. Dickfeldt has received a research grant from and is a consultant to Biosense Webster. Dr. Weiss is a consultant to Stereotaxis. Dr. Stevenson is the recipient of a patent for needle ablation consigned to Brigham and Women’s Hospital. Dr. Marchlinski is a consultant to Biosense Webster, Medtronic, and Boston Scientific. Dr. Della Bella is a consultant to St. Jude Medical; and has received honoraria for lectures from Biosense Webster, St. Jude Medical, and Biotronik. Dr. Callans has served as a consultant for Biosense Webster and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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