Catheter ablation of ventricular tachycardia in structural heart disease had a 31% mortality rate over 34 months, with higher LVEDV, male gender, COPD, and AF as independent predictors.
Cohort (n=309)
What are the independent predictors of long-term mortality in patients with structural heart disease undergoing catheter ablation for ventricular tachycardia?
In patients with structural heart disease undergoing VT ablation, higher LVEDV, male gender, COPD, AF, polymorphic VTs, antiarrhythmic use, and periprocedural complications independently predict long-term mortality.
AIMS: Ablation of ventricular tachycardias (VTs) in patients with structural heart disease has been established in the past decades as an effective and safe treatment. However, the prognosis and long-term outcome remains poor. METHODS AND RESULTS: We investigated 309 patients with ischaemic cardiomyopathy (ICM) and non-ischaemic cardiomyopathy (NICM) (186 ICM, 123 NICM; 271 males; mean age 64.1 ± 12 years; ejection fraction 34 ± 13%) after ≥1 VT ablations over a mean follow-up period of 34 ± 28 months. Electrical storm was the indication for 224 patients (73%), whereas 86 patients (28%) underwent epicardial as well as endocardial ablation. During follow-up, 132 patients (43%) experienced VT recurrence and 97 (31%) died. Ischaemic cardiomyopathy and NICM patients showed comparable results, regarding procedural endpoints, complications, VT recurrence and survival. The Cox-regression analysis for all-cause mortality revealed that the presence of higher left ventricular end-diastolic volume (LVEDV; P < 0.001), male gender (P = 0.018), atrial fibrillation (AF; P < 0.001), chronic obstructive pulmonary disease (COPD; P = 0.001), antiarrhythmic drugs during the follow-up (P < 0.001), polymorphic VTs (P = 0.028), and periprocedural complications (P = 0.001) were independent predictors of mortality. CONCLUSION: Ischaemic cardiomyopathy and NICM patients undergoing VT ablation had comparable results regarding procedural endpoints, complications, VT recurrence and 3-year mortality. Higher LVEDV, male gender, COPD, AF, polymorphic VTs, use of antiarrhythmics, and periprocedural complications are strong and independent predictors for increased mortality. The PAINESD score accurately predicted the long-term outcome in our cohort.
Darma et al. (Fri,) conducted a cohort in Ventricular tachycardia in structural heart disease (n=309). Catheter ablation was evaluated on All-cause mortality. Catheter ablation of ventricular tachycardia in structural heart disease had a 31% mortality rate over 34 months, with higher LVEDV, male gender, COPD, and AF as independent predictors.
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