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Preprocedural Scar Assessment for VT Ablation Risk
Quick Takes
- A retrospective analysis of CT-derived total scar volume (TSV) in patients undergoing VT ablation revealed an association with periprocedural acute hemodynamic decompensation (AHD). Among 61 patients with TSV data, 13 (21%) had periprocedural AHD.
- When added to the PAINESD score, TSV improved predictability of AHD, particularly in the nonischemic cohort.
Study Questions:
Does the addition of total scar volume (TSV) by preprocedure computed tomography (CT) provide adjunctive prognostic information beyond the previously reported PAINESD risk score to help predict periprocedural acute hemodynamic decompensation (AHD) in patients undergoing ventricular tachycardia (VT) ablation?
Methods:
The authors performed a retrospective analysis of all VT ablations at a single center over a 5-year period and assessed the associations between TSV and AHD.
Results:
Among 61 patients with TSV data, 13 (21%) had periprocedural AHD. TSV and PAINESD were independently associated with AHD risk. Both TSV and PAINESD were associated with AHD. The highest TSV tertile (>37.30 mL) showed a significant association with AHD (odds ratio, 4.80) compared to those in other tertiles. PAINESD score and PAINES2D score (PAINESD and TSV) had a significant impact on AHD. PAINES2D score had a greater impact on AHD compared to PAINESD.
Conclusions:
The authors found that the addition of TSV to a modified PAINESD—PAINES2D—improved risk prediction of AHD.
Perspective:
The previously reported PAINESD risk score (Santangeli P, et al., J Am Coll Cardiol 2017;69:2105-15) was created to predict the occurrence of periprocedural AHD and its associated risk of mortality. It was derived from a sample of over 2,000 patients from 12 international centers. The following variables were identified: pulmonary disease, age >60 years, the presence of ischemic cardiomyopathy, New York Heart Association functional class III or IV, left ventricular ejection fraction <25%, VT storm, and diabetes. The PAINESD score assigns a specific number of points based on each variable. A score >15 is high risk for early mortality.
The authors of the present study found that the TSV derived from preprocedural CT improved the predictability of periprocedural AHD beyond the PAINESD risk score. The TSV appeared particularly useful in patients with nonischemic cardiomyopathy, whose PAINESD score is, by definition, reduced by 3 points compared to patients with ischemic structural heart disease. The current study is relatively small and should be validated in larger cohorts. If confirmed, the incorporation of TSV into PAINESD may help identify an additional group of patients with significant scar burden who may benefit from greater preparedness for hemodynamic support at the time of their VT ablation.
Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Computed Tomography, Nuclear Imaging
Keywords: Arrhythmias, Cardiac, Cardiomyopathies, Catheter Ablation, Diabetes Mellitus, Hemodynamics, Heart Failure, Myocardial Ischemia, Risk Assessment, Tachycardia, Ventricular, Tomography, X-Ray Computed
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