Safety of Ventricular Tachycardia Ablation in Clinical Practice

Katz, David F.; Turakhia, Mintu P.; Sauer, William H.; Tzou, Wendy S.; Heath, Russell R.; Zipse, Matthew M.; Aleong, Ryan G.; Varosy, Paul D.; Kao, David

doi:10.1161/circep.114.002336

Cited by 59 publications

(25 citation statements)

References 29 publications

(70 reference statements)

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“…Further, the 10% complication rate observed among the NYHA IV patients was comparable to the 6% to 15% complication rate that has been reported in other single-and multi-center studies evaluating VT ablation in patients with structural heart disease and without the same degree of HF. 4,[17][18][19][20][21][22] Not surprisingly, operators chose to use hemodynamic support more often in these patients. This procedural characteristic may have allowed for greater safety in performing the ablation and minimizing hemodynamic compromise because of sedation or anesthesia effects, VT induction, and, in some cases, mapping during VT.…”

Section: Differences In Procedural Strategy To Safely Perform Cathetementioning

confidence: 99%

“…Members of the IVTCC are all higher volume, tertiary referral VT ablation centers and thus may have different patient populations and results compared with less specialized, lower volume sites. 19 Ablation of such patients in this study was performed not only at tertiary referral centers with advanced ablation experience but also with on-site capability for interdisciplinary collaboration; these factors should all be considered and included in the management of NYHA IV patients with VT.…”

Section: Limitationsmentioning

confidence: 99%

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Ventricular Tachycardia Ablation in Severe Heart Failure

Tzou¹,

Tung²,

Frankel³

et al. 2017

Circ: Arrhythmia and Electrophysiology

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Background— Ventricular tachycardia (VT) radiofrequency ablation has been associated with reduced VT recurrence and mortality, although it is typically not considered among New York Heart Association class IV (NYHA IV) heart failure patients. We compared characteristics and VT radiofrequency ablation outcomes of those with and without NYHA IV in the International VT Ablation Center Collaboration. Methods and Results— NYHA II–IV patients undergoing VT radiofrequency ablation at 12 international centers were included. Clinical variables, VT recurrence, and mortality were analyzed by NYHA IV status using Kaplan–Meier analysis and Cox proportional hazard models. There were significant differences between NYHA IV (n=111) and NYHA II and III (n=1254) patients: NYHA IV had lower left ventricular ejection fraction; more had diabetes mellitus, kidney disease, cardiac resynchronization implantable cardioverter–defibrillator, and VT storm despite greater antiarrhythmic drug use ( P <0.01). NYHA IV subjects required more hemodynamic support, were inducible for more and slower VTs, and were less likely to undergo final programmed stimulation. There was no significant difference in acute complications. In-hospital deaths, recurrent VT, and 1-year mortality were higher in the NYHA IV group, in the context of greater baseline comorbidities. Importantly, NYHA IV patients without recurrent VT had similar survival compared with NYHA II and III patients with recurrent VT (68% versus 73%). Early VT recurrence (≤30 days) was significantly associated with mortality, especially in NYHA IV patients. Conclusions— Despite greater baseline comorbidities, VT radiofrequency ablation can be safely performed among NYHA IV patients. Early VT recurrence is significantly associated with subsequent mortality regardless of NYHA status. Elimination of recurrent VT in NYHA IV patients may reduce mortality to a level comparable to NYHA II and III with arrhythmia recurrence.

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Section: Differences In Procedural Strategy To Safely Perform Cathetementioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Ventricular Tachycardia Ablation in Severe Heart Failure

Tzou¹,

Tung²,

Frankel³

et al. 2017

Circ: Arrhythmia and Electrophysiology

Self Cite

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“…In a recent retrospective analysis assessing 9,699 discharge records, adverse event rates were seen in 8.5% and major adverse events in 3% with procedural death rates of 1.1%. 9 The authors report no conflicts of interest.…”

Section: Current Statementioning

confidence: 95%

Catheter Ablation at the Forefront: The Tribulations of Clinical Trials

Bradfield¹,

Tung²

2016

JICRM

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ABSTRACT. Radiofrequency ablation (RFA) has become an essential component of ventricular tachycardia (VT) management. In the era of implantable cardioverter-defibrillators (ICDs), antiarrhythmic therapy and RFA are frequently required for patients with both primary prevention and secondary prevention indications for ICD implant. ''VT ablation'' encompasses ablation across a spectrum of various ventricular arrhythmias. In addition to ablation of monomorphic VT in the setting of structural heart disease, the evolving field also includes VT in structurally normal hearts (idiopathic VT), premature ventricular contractions (PVC) ablation (for symptoms and optimization of cardiomyopathy), and ablation of ventricular fibrillation via targeting of triggering PVCs. While these sub-categories of VT ablation represent significant advancement in the breadth of the field, the focus of this article is to review the evidence for catheter ablation of monomorphic VT in the setting of structural heart disease and to discuss future studies that are anticipated.

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“…64 Inhospital mortality was similarly found to be 1.1% among 9699 VT ablation patients from 1994 to 2011, in hospital discharge claims data from 6 states. 81 The Ventricular Tachycardia before defibrillator implantation in patients with Coronary Heart disease (VTACH) and the Substrate Mapping and Ablation in Sinus Rhythm to Halt Ventricular Tachycardia (SMASH-VT) trials are randomized trials of VT ablation versus no ablation at the time of ICD implant for secondary prevention, ischemic cardiomyopathy patients. 82,83 The primary endpoint of the VTACH trial was time to first recurrence of VT, which was longer (18.6 months) in the ablation arm compared with the control arm with (5.9 months) (P 5 .051).…”

Section: Ablation For the Treatment And Prevention Of Ventricular Tacmentioning

confidence: 99%