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

Frankel, David S.; Tung, Roderick; Vaseghi, Marmar; Sauer, William H.; Tzou, Wendy S.; Mathuria, Nilesh; Dickfeldt, Timm M.; Lakkireddy, Dhanunjaya; Bunch, T. Jared; Biase, Luigi Di; Tholakanahalli, Venkat; Tedrow, Usha B.; Kumar, Saurabh; Stevenson, William G.; Bella, Paolo Della; Shivkumar, Kalyanam; Marchlinski, Francis E.; Callans, David J.

doi:10.1016/j.jacc.2017.02.044

Cited by 149 publications

(102 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In addition, catheter ablation of ventricular tachycardia is associated with high risks of procedural complication and death. 23 SBRT has the potential to overcome these challenges. 8,9 In this case series, we combined noninvasive mapping (electrocardiographic imaging) and noninvasive ablation (SBRT) to treat patients with refractory ventricular tachycardia.…”

mentioning

confidence: 99%

Noninvasive Cardiac Radiation for Ablation of Ventricular Tachycardia

Schill²,

et al. 2017

View full text Add to dashboard Cite

BACKGROUND Recent advances have enabled noninvasive mapping of cardiac arrhythmias with electrocardiographic imaging and noninvasive delivery of precise ablative radiation with stereotactic body radiation therapy (SBRT). We combined these techniques to perform catheter-free, electrophysiology-guided, noninvasive cardiac radioablation for ventricular tachycardia. METHODS We targeted arrhythmogenic scar regions by combining anatomical imaging with noninvasive electrocardiographic imaging during ventricular tachycardia that was induced by means of an implantable cardioverter–defibrillator (ICD). SBRT simulation, planning, and treatments were performed with the use of standard techniques. Patients were treated with a single fraction of 25 Gy while awake. Efficacy was assessed by counting episodes of ventricular tachycardia, as recorded by ICDs. Safety was assessed by means of serial cardiac and thoracic imaging. RESULTS From April through November 2015, five patients with high-risk, refractory ventricular tachycardia underwent treatment. The mean noninvasive ablation time was 14 minutes (range, 11 to 18). During the 3 months before treatment, the patients had a combined history of 6577 episodes of ventricular tachycardia. During a 6-week postablation “blanking period” (when arrhythmias may occur owing to postablation inflammation), there were 680 episodes of ventricular tachycardia. After the 6-week blanking period, there were 4 episodes of ventricular tachycardia over the next 46 patient-months, for a reduction from baseline of 99.9%. A reduction in episodes of ventricular tachycardia occurred in all five patients. The mean left ventricular ejection fraction did not decrease with treatment. At 3 months, adjacent lung showed opacities consistent with mild inflammatory changes, which had resolved by 1 year. CONCLUSIONS In five patients with refractory ventricular tachycardia, noninvasive treatment with electrophysiology-guided cardiac radioablation markedly reduced the burden of ventricular tachycardia. (Funded by Barnes–Jewish Hospital Foundation and others.)

show abstract

mentioning

confidence: 99%

Noninvasive Cardiac Radiation for Ablation of Ventricular Tachycardia

Schill²,

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Death due to worsening heart failure is common in this population, and predictors of death in this group are also predictors of death in advanced heart failure (6). VT in this setting may be Although the rate of periprocedural cerebral ischemic events was low in the present study, with only 9 episodes (7 strokes, 2 transient ischemic attacks), 2 strokes were fatal (4). Recent data from a small case series suggest that silent cerebral ischemia may complicate as many as 63% of left ventricular ablation procedures (8).…”

mentioning

confidence: 47%

“…In this issue of the Journal, Santangeli et al (4) present the early (31-day) mortality data from a multicenter registry of VT ablation in the context of structural heart disease. In this large registry, 2,061 patients underwent RCA for VT, of whom 47% had nonischemic cardiomyopathy, 33% had severe heart failure symptoms, and 35% presented with VT storm.…”

mentioning

confidence: 99%

Risk Factors for Early Mortality After VT Ablation

Sacher

Martin

2017

Journal of the American College of Cardiology

View full text Add to dashboard Cite

R adiofrequency catheter ablation (RCA) has become a standard component of management strategies for recurrent ventricular tachycardia (VT) that results from ventricular scar.Current consensus favors catheter ablation to reduce symptoms due to VT recurrence and implantable cardioverter-defibrillator (ICD) shocks, although a mortality benefit of catheter ablation has not been proven. In the recent VANISH (Ventricular Tachy-cardia Ablation versus Escalated Antiarrhythmic Drug Therapy in Ischemic Heart Disease) trial, RCA in patients with ischemic cardiomyopathy and VT despite amiodarone therapy reduced the combined endpoint of death, VT storm, and ICD shocks compared with further escalation of antiarrhythmic drug therapy (1). This result was driven by reductions in VT storm and ICD shocks, rather than a mortality benefit. Two other randomized trials of VT ablation in patients with ischemic cardiomyopathy also reported reductions in VT recurrence (but no mortality benefit) with RCA versus a control arm without antiarrhythmic drug escalation (2,3). Importantly, none of these trials was sufficiently powered to detect mortality differences.In this issue of the Journal, Santangeli et al. (4) present the early (31-day) mortality data from a multicenter registry of VT ablation in the context of structural heart disease. In this large registry, 2,061 patients underwent RCA for VT, of whom 47% had nonischemic cardiomyopathy, 33% had severe heart failure symptoms, and 35% presented with VT storm.Fifty-six percent of the patients had unmappable arrhythmias, and in only 67% was VT demonstrated to be noninducible after ablation. These data, therefore, represent a typical population undergoing VT ablation. The association between VT recurrence and 1-year mortality in the same cohort has been published previously; the overall combined transplant/ mortality rate was 15% at 1 year but 29% in those with recurrent VT (5). In the present study, the authors focused on early mortality, which reflects patient baseline characteristics, as well as acute hospital care.Overall, 5% of patients died within 31 days of RCA after major procedural complications in only 0.6%.Not surprisingly, the sickest patients (those with poor ventricular function, renal impairment, and VT storm) had a higher risk of early mortality. Procedural factors such as inducibility of unmappable VT and recurrence after RCA were also associated with increased mortality. Although VT recurrence was associated with a higher risk of death, only 22% of deaths were known to be arrhythmic, and one-half were known not to be. Even in those who died after recurrence of VT, death was known to be VT related in only 40%. These results are in keeping with randomized trials and make progress in explaining the difficulty in demonstrating a mortality benefit from VT ablation. Death due to worsening heart failure is common in this population, and predictors of death in this group are also predictors of death in advanced heart failure (6). VT in this setting may be

show abstract

“…A combined approach to the VT management using antiarrhythmic drugs and radiofrequency catheter ablation (RFA) is often required to control such VTs 1, 2, 3…”

Section: Introductionmentioning

confidence: 99%

Pathology after a combination of sequential and simultaneous unipolar radiofrequency ablation of ventricular tachycardia in a postmortem heart with cardiac sarcoidosis

Miyamoto

Matsuyama

Noda

et al. 2018

Clinical Case Reports

View full text Add to dashboard Cite

Key Clinical MessageThis report shows a postmortem examination of a heart performed in a patient with cardiac sarcoidosis undergoing a sequential and simultaneous unipolar radiofrequency ablation. A combination of a sequential and simultaneous unipolar radiofrequency ablation might be useful for creating transmural ablation lesions on the interventricular septum in patients with cardiac sarcoidosis.

show abstract

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

Cited by 149 publications

References 27 publications

Noninvasive Cardiac Radiation for Ablation of Ventricular Tachycardia

Noninvasive Cardiac Radiation for Ablation of Ventricular Tachycardia

Risk Factors for Early Mortality After VT Ablation

Pathology after a combination of sequential and simultaneous unipolar radiofrequency ablation of ventricular tachycardia in a postmortem heart with cardiac sarcoidosis

Contact Info

Product

Resources

About