Prognostic Impact of the Timing of Recurrence of Infarct-Related Ventricular Tachycardia After Catheter Ablation

Abstract

Background Recurrence of ventricular tachycardia (VT) after ablation in patients with previous myocardial infarction is associated with adverse prognosis. However, the impact of the timing of VT recurrence on outcomes is unclear. Methods and Results We analyzed data from a multicenter collaborative database of patients who underwent catheter ablation for infarct-related VT. Multivariable Cox regression analyses investigated the effect of the timing of VT recurrence on the composite outcome of death or heart transplantation using VT recurrence as a time-varying covariate. A total of 1412 patients were included (92% men; age: 66.7±10.7 years), and 605 patients (42.8%) had a recurrence after median 116 days (188 [31.1%] within 1 month, 239 [39.5%] between 1 and 12 months, and 178 [29.4%] after 12 months). At median follow-up of 670 days, 375 patients (26.6%) experienced death or heart transplantation. The median time from recurrence to death or heart transplantation was 65 and 198.5 days in patients with recurrence ≤30 days and >30 days post ablation, respectively. The adjusted hazard ratio (95% confidence interval) for the effect of VT recurrence occurring immediately post ablation on death or heart transplantation was 3.45 (2.33–5.11) in reference to no recurrence. However, the magnitude of this effect decreased statistically significantly (P<0.001) as recurrence occurred later in the follow-up period. The respective risk estimates for VT recurrence at 30 days, 6 months, 1 year, and 2 years were 3.36 (2.29–4.93), 2.94 (2.09–4.14), 2.50 (1.85–3.37), and 1.81 (1.37–2.40). Conclusions VT recurrence post ablation is associated with a mortality risk that is highest soon after the ablation and decreases gradually thereafter.

Impact of timing of recurrence following catheter ablation of scar‐related ventricular tachycardia on subsequent mortality

“…Our findings confirm and extend these results to a more general population of patients with scar‐related VT, including subjects with nonischemic cardiomyopathy. At variance with the findings by Siontis et al . we found a nonsignificant increase in mortality risk for VT recurrence events occurring after 6 months from the index procedure.…”

“…Indeed, more than 50% of the death events at 2 years occurred in patients who had experienced recurrent VT within the first 6 months postprocedure with an almost sixfold increased risk of mortality. In a recently published multicenter registry including patients with infarct‐related VT undergoing VT ablation, patients with early recurrence (within 1 month) had a threefold higher risk of mortality during follow‐up, and there was a progressive decline in the subsequent mortality risk for later VT recurrences of up to 3 years after the index procedure, when the risk became comparable to patients without recurrence . Our findings confirm and extend these results to a more general population of patients with scar‐related VT, including subjects with nonischemic cardiomyopathy.…”

2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias

“…Although observational studies have demonstrated an association between recurrent VAs and mortality ( S12.1.4.12 – S12.1.4.15 ), no prospective study thus far has demonstrated a significant beneficial effect of VT ablation on survival. Successful completion of a prospective trial of VT ablation with a primary outcome of mortality is challenging due to competing mortality risks in patients with VT.…”

Intrapericardial cardiosphere-derived cells hinder epicardial dense scar expansion and promote electrical homogeneity in a porcine post-infarction model

“…arrythmogenic cardiomyopathy, postviral myocarditis, etc.) (Siontis et al, 2016). Despite the above, these results are a proof-of-concept that CDCs administered into the pericardial sac modify epicardial scar remodelling (both anatomically and functionally).…”