Key result
Chronic coronary total occlusion fails to independently predict ventricular arrhythmia recurrence despite higher crude rates.
Why the study?
Chronic coronary total occlusions are considered an emerging predictor of ventricular arrhythmias, but data on arrhythmic outcomes in affected patients undergoing catheter ablation are limited.
Does the presence of unrevascularized chronic coronary total occlusion predict ventricular arrhythmias recurrence in patients undergoing radiofrequency catheter ablation?
Observational (n=120)
No
Does the presence of unrevascularized chronic coronary total occlusion predict ventricular arrhythmias recurrence in patients undergoing radiofrequency catheter ablation?
Hazard Ratio: 1.8 (95% CI 1.03–3.1)
Absolute Event Rate: 64% vs 46%
p-value: p=0.04
In patients undergoing catheter ablation for ventricular arrhythmias, severe left ventricular dysfunction, rather than the presence of an unrevascularized chronic total occlusion, is the independent predictor of arrhythmia recurrence.
Unrevascularized CTO should not guide ablation decisions in VA patients; leaves open whether revascularization modifies recurrence beyond LV dysfunction.
Chronic coronary total occlusions (CTO) are considered an emerging predictor of ventricular arrhythmias (VAs), but currently there are few data on arrhythmic outcomes in patients affected by CTO undergoing radiofrequency catheter ablation of VAs. This study sought to evaluate the impact of unrevascularized CTO on the recurrence of VAs after catheter ablation. This was a single-center retrospective study enrolling 120 patients between 2015 and 2020. All patients were admitted for ventricular tachycardia (VT) or high premature ventricular contractions burden (>25% detected by Holter ECG), without evidence of acute coronary syndrome; they underwent coronary angiography, electrophysiology (EP) study, and three-dimensional electroanatomic mapping (3D-EAM) followed by VAs ablation. Twenty-eight patients (23%) of 120 patients showed CTO at coronary angiography. At baseline, the CTO group presented with higher prevalence of hypertension, chronic renal disease, systolic ventricular dysfunction, secondary prevention ICD implantation, and higher rate of LAVA by 3D-EAM compared with the non-CTO group. At a median follow-up of 15 months (range 1−96 months) after catheter ablation, the only independent predictor of VAs recurrence was the presence of moderate to severe left ventricular (LV) dysfunction. Therefore, the presence of CTO does not predict VAs recurrence after catheter ablation, which is instead predicted by LV dysfunction.
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Narducci et al. (2022) conducted an observational in Ventricular arrhythmias (n=120). Chronic coronary total occlusion (CTO) vs. Non-CTO was evaluated on Ventricular arrhythmia recurrence (monomorphic PVCs ≥ 25% at 24h ECG Holter or SVT or VF or appropriate ICD interventions) (HR 1.8, 95% CI 1.03-3.1, p=0.04). Chronic coronary total occlusion was associated with a higher unadjusted rate of ventricular arrhythmia recurrence compared to non-CTO (64% vs 46%, HR 1.8), but was not an independent predictor after multivariate adjustment.
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