Safety of Ventricular Tachycardia Ablation | Journal Scan
Is ablation of ventricular tachycardia (VT) as safe in the real world as in the published literature?
Using administrative data from six states, the authors identified hospitalizations with primary diagnosis of VT and cardiac ablation. In-hospital adverse events (AEs) were defined as death, stroke, intracerebral hemorrhage, pericardial complications, hematoma, hemorrhage, blood transfusion, and cardiogenic shock. Major adverse events (MAE) included stroke, tamponade, and death. Worsening heart failure following ablation, respiratory failure, and heart block were not included. Multivariable mixed-effects models were used to identify patient and hospital characteristics associated with AEs.
There were 9,699 hospitalizations with VT ablations. AEs occurred in 825 (8.5%), MAEs in 295 (3.0%), and death in 110 (1.1%). Heart failure had the strongest association with death (odds ratio [OR], 5.52; 95% CI, 2.97-10.3) and MAE (OR, 2.99; 95% CI, 2.15-4.16). Anemia (OR, 4.84; 95% CI, 3.79-6.19) and unscheduled admission (OR, 1.64; 95% CI, 1.37-1.97) were associated with AEs. Need for blood transfusion was the most common adverse event associated with VT ablation, occurring in 224 (2.3%) hospitalizations. Hospital volume >25 cases/year was associated with fewer AEs compared with lower-volume centers (6.4% vs. 8.8%, p = 0.008). Over the study period, the incidence of AEs increased, as did the burden of AE risk factors.
The authors concluded that AE rates in clinical practice are similar to those reported in the literature, and that ablations done electively and at hospitals with higher procedural volumes are associated with fewer AEs.
This analysis spans two decades of endocardial VT ablation. So much has changed in our knowledge and understanding of the arrhythmia mechanisms and the tools to map and ablate it. It is reassuring to see that the complication rate of the procedure in the real world is similar to that in the published literature from expert centers. As is true with so many other procedures, the safety of the VT ablation is higher in high-volume centers. The threshold for a high-volume center was only 25, which is quite low, and it would be interesting to explore the safety of the procedure in more granularity across the quartiles of volume of both the hospital and individual operators. This study was not designed to evaluate efficacy of the ablation procedures, the other key part in the risk benefit assessment.
Keywords: Tachycardia, Ventricular, Tachycardia, Catheter Ablation, Anemia, Blood Transfusion, Cerebral Hemorrhage, Heart Failure, Hematoma, Hospitalization, Shock, Cardiogenic, Risk Assessment, Stroke
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