Predictors of long-term mortality after catheter ablation of ventricular tachycardia in a contemporary cohort of patients with structural heart disease

Cardiovasc electrophysiol

Torri

et al. 2021

Self Cite

Introduction This study sought to examine gender differences in patients with structural heart disease (SHD) referred for ablation of ventricular tachycardia (VT). Background Female patients are often underrepresented in large studies. Significant differences in the clinical presentation, treatment, and prognosis of female patients have been described in previous studies. Methods and Results We investigated 88 female patients with SHD undergoing VT ablation (mean age 59 years, 56% nonischemic cardiomyopathy, mean left ventricular ejection fraction 35%, 82% in electrical storm). A case‐control study with 88 male patients was performed and the results regarding clinical and procedural characteristics, acute and long‐term results of the two groups were compared. The female patients had more arrhythmogenic substrate, as they more commonly presented with electrical storm (p = .016) and had a higher number of inducible VT morphologies during the procedure (p = .018). Moreover, the female patients were less likely to have an optimized heart failure medical treatment at baseline (p = .030) and required more time from the first manifestation of the VT to ablation referral (p = .034). Although fewer epicardial ablations were performed in female patients (p = .019), the two groups showed similar results regarding VT noninducibility as ablation endpoint (p = .844), major procedure‐related complications (p = .719) and freedom from VT during follow‐up (p = .268). Moreover, the overall mortality in the two groups was similar (p = .176). Advanced NYHA class was associated with worse transplant and assist‐device‐free survival in the female group. Conclusion Female patients presenting for VT ablation had more arrhythmogenic substrate and were less likely to have an optimized heart failure medical treatment. Nevertheless, the procedural acute and long‐term outcomes between the two genders were similar.

Section: Methodsmentioning

confidence: 99%

Gender differences in patients with structural heart disease undergoing VT ablation

Cardiovasc electrophysiol

Torri

et al. 2021

Self Cite

“…[ 10 ] report 41% of patients reaching the primary endpoint of assist device/HTX or death after 1.2 years of follow-up. Accordingly, the present authors reported in their published study [ 11 ] a mortality rate of 31% with 5% of patients undergoing an LVAD implantation and 3% receiving HTX, reaching to a combined endpoint of LVAD/HTX or death of 36% within the 4‑year follow-up.…”

Section: Discussionmentioning

confidence: 86%

“…The methodology of the procedure has been described in detail elsewhere [ 11 ]. In brief, after deep sedation, femoral vein access was used to place one decapolar catheter in the coronary sinus and one quadripolar catheter in the right ventricular apex.…”

Section: Methodsmentioning

confidence: 99%

Role of assist device implantation and heart transplantation in the long-term outcome of patients with structural heart disease after catheter ablation of ventricular tachycardia

Dinov

et al. 2021

Herzschr Elektrophys

Self Cite

Introduction Ablation of ventricular tachycardias (VTs) in patients with structural heart disease (SHD) has been associated with advanced heart failure and poor survival. Methods and results This matched case-control study sought to assess the difference in survival after left ventricular assist device (LVAD) implantation and/or heart transplantation (HTX) in SHD patients undergoing VT ablation. From the initial cohort of 309 SHD patients undergoing VT ablation (187 ischemic cardiomyopathy, mean age 64 ± 12 years, ejection fraction of 34 ± 13%), 15 patients received an LVAD and nine patients HTX after VT ablation during a follow-up period of 44 ± 33 months. Long-term survival after LVAD did not differ from the matched control group (p = 0.761), although the cause of lethal events was different. All post-HTX patients survived during follow-up. Conclusion In this matched case-control study on patients with SHD undergoing VT ablation, patients that received LVAD implantation had similar survival compared to the control group after 4‑year follow-up, while the patients with HTX had a significantly better outcome.

“…During 2012–2015, 309 patients with SHD underwent one or multiple VT‐ablations in our center. For the purpose of the analysis, we only compared patients younger than 75 years in reference 8 to our current cohort. When compared to the 241 patients under 75 years, the 68 geriatric patients had similar results concerning noninducibility as the endpoint (86% vs. 85%; p = .911) and arrhythmia recurrence (45% vs. 34%; p = .113).…”

Section: Discussionmentioning

confidence: 99%

“…The methodology of the ablation has been described in detail elsewhere 8 . In brief, femoral venous vein access was used to place one decapolar catheter in the coronary sinus and one quadripolar catheter in the right ventricular apex.…”

Section: Methodsmentioning

confidence: 99%

VT ablation in geriatric patients with structural heart disease: Should there still be an age limit?

Cardiovasc electrophysiol

Dinov

et al. 2021

Self Cite

Introduction This study sought to examine the feasibility and outcome of ablation of ventricular tachycardias (VTs) in a contemporary cohort of geriatric patients with structural heart disease (SHD). Background Geriatric patients are often underrepresented in large studies. As frailty is becoming an increasing problem, we need to examine the best course of action for this population. Methods and Results We investigated 68 SHD‐patients ≥ 75 years old undergoing VT‐ablation (men 88%, ischemic cardiomyopathy 77%, electrical storm 72%, mean left ventricular ejection fraction 31%) and divided the cohort into two groups: 75–79 years old (n = 51) and ≥80 years old (n = 17). The two groups showed similar results regarding noninducibility as ablation endpoint (p = .693), major procedure‐related complications (p = .488), and VT‐recurrence (p = .882) during the 39‐month follow‐up. At the end of the follow‐up, 10 patients in the octogenarian group (59%) versus 16 patients of the other group (31%) died. Conclusion Geriatric patients with SHD including octogenarians showed similar results regarding procedural endpoints, freedom of VT, and major procedure‐associated complications after VT‐ablation. When ablation is indicated, age alone should not be an inhibiting factor to treat these patients.