Early Mortality After Ventricular Tachycardia Ablation

Apr 24, 2017
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Authors:
Santangeli P, Frankel DS, Tung R, et al.
Citation:
Early Mortality After Catheter Ablation of Ventricular Tachycardia in Patients With Structural Heart Disease. J Am Coll Cardiol 2017;69:2105-2115.
Summary By:
Fred Morady, MD, FACC

Study Questions:

What is the mortality rate of ventricular tachycardia (VT) catheter ablation (CA) within 31 days of the procedure in patients with structural heart disease (SHD)?

Methods:

This retrospective cohort study included 2,061 patients (mean age 62 years) with VT who were recruited at 12 centers and who had SHD (mean ejection fraction [EF] 34%, ischemic heart disease in 53%). Multiple variables were analyzed to identify predictors of early mortality after CA.

Results:

Early mortality after VT CA was 5%. Sixty percent of these deaths occurred before hospital discharge (median 9 days post-CA). Overall, 0.6% of deaths were attributable to a major procedural complication. The independent predictors of early mortality after CA were: EF (odds ratio [OR] 1.12 per 1% decrease in EF, chronic kidney disease (OR 2.7), presentation with VT storm (OR 3.6), presence of unmappable VT (OR 5.7), and recurrent VT post-ablation (OR 11.4).

Conclusions:

The early mortality rate in this large cohort of patients with SHD who underwent CA of VT was 5%. Early mortality can be predicted by several variables that are indicators of more severe SHD and/or unsuccessful or incomplete CA of VT.

Perspective:

The major strength of this study is the very large sample size of >2,000 patients. It is useful to identify predictors of early mortality, but other than using these predictors to screen out high-risk patients, it is not clear how knowledge of these predictors can be used to improve outcomes after VT CA.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Atherosclerotic Disease (CAD/PAD), Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: Arrhythmias, Cardiac, Catheter Ablation, Coronary Artery Disease, Heart Failure, Mortality, Premature, Myocardial Ischemia, Patient Outcome Assessment, Renal Insufficiency, Chronic, Secondary Prevention, Stroke Volume, Tachycardia, Ventricular


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