Ventricular Tachycardia Ablation in Severe Heart Failure

Wendy S. Tzou; Roderick Tung; David S. Frankel; Marmar Vaseghi; T. Jared Bunch; Luigi Di Biase; Venkatakrishna N. Tholakanahalli; Dhanunjaya Lakkireddy; Timm Dickfeld; Anastasios Saliaris; J. Peter Weiss; Nilesh Mathuria; Usha B. Tedrow; Mohammed Rauf Afzal; Pasquale Vergara; Koichi Nagashima; Mehul Patel; Shiro Nakahara; Kairav Vakil; J. David Burkhardt; Chi‐Hong Tseng; Andrea Natale; Kalyanam Shivkumar; David J. Callans; William G. Stevenson; Paolo Della Bella; Francis E. Marchlinski; William H. Sauer

doi:10.1161/circep.116.004494

Why the study?

Is ventricular tachycardia radiofrequency ablation safe in NYHA IV heart failure patients, and does elimination of recurrent VT improve mortality?

Structured PICO

Is ventricular tachycardia radiofrequency ablation safe in NYHA IV heart failure patients, and does elimination of recurrent VT improve mortality?

P

Population

Patients with severe heart failure (NYHA class IV) and ventricular tachycardia, as well as NYHA class II and III patients for comparison.

I

Intervention

Ventricular tachycardia (VT) radiofrequency ablation

C

Comparator

NYHA class II and III patients, and patients with versus without VT recurrence

O

Outcome

Safety, early VT recurrence, and subsequent mortalityhard clinical

VT radiofrequency ablation is safe in NYHA IV heart failure patients, and successful elimination of VT may significantly improve survival in this high-risk population.

Implication

May support considering VT ablation in NYHA IV patients; leaves open randomized confirmation of mortality benefit.

Abstract

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.