Key result
New-onset ventricular tachycardia occurred in 2.6% of patients early after successful percutaneous coronary intervention for chronic total occlusion, with impaired left ventricular systolic function as the only independent predictor.
Why the study?
Benefits of CTO-PCI must be weighed against complication risks, and the incidence of new-onset ventricular tachycardia after successful CTO-PCI had not been investigated.
What is the incidence and what are the predictors of new-onset ventricular tachycardia after successful percutaneous coronary intervention of chronic total occlusions?
Observational (n=342)
No
What is the incidence and what are the predictors of new-onset ventricular tachycardia after successful percutaneous coronary intervention of chronic total occlusions?
Ventricular tachycardia is a rare but early complication after successful CTO-PCI, occurring in 2.6% of patients, primarily driven by impaired left ventricular systolic function.
May warrant closer monitoring in patients with impaired LV systolic function after CTO-PCI; hypothesis-generating for risk stratification.
Objectives This study sought to investigate the prevalence of ventricular tachycardia after percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). Background PCI of a CTO is associated with improvement of the left ventricular ejection fraction and possibly associated with reduced mortality. However, benefits of CTO-PCI must be weighed against a higher risk of procedure-related complications. The incidence of new-onset ventricular tachycardia after a successful CTO-PCI has not been investigated so far. In this retrospective registry we seek to describe characteristics and predictors of occurrence of post-procedural ventricular tachycardias. Methods and results Between 2010 and 2015, 485 patients underwent successful CTO-PCI at Heart Center Leipzig. Of them, 342 had complete follow-up and were further analyzed. Ventricular tachycardias were detected in 9 (2.6%) patients. All of them were monomorphic ventricular tachycardias occurring in median 1 day (interquartile range [IQR] 0.25–4.75 days) after PCI and caused prolongation of the hospital stay. Patients with ventricular tachycardia were older, had worse left ventricular ejection fraction (mean 33.1%, SD 5.9%) and more frequently a CTO of an infarct-related artery. The target vessel was not associated with the occurrence of ventricular arrhythmias. In multivariable analysis, only impaired left ventricular systolic function was an independent predictor for procedure-related ventricular tachycardia. Mortality rates were not different between patients with or without ventricular tachycardia. Conclusion Ventricular tachycardia can occur early after CTO-PCI as possible reperfusion arrhythmia and poorer left ventricular ejection fraction is the only independent predictor for onset. Although the occurrence of ventricular tachycardia after CTO-PCI seems not to influence mortality, awareness of this possible complication and longer monitoring may be recommended.
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König et al. (2019) conducted an observational in Chronic total occlusion (n=342). Percutaneous coronary intervention of chronic total occlusion was evaluated on New-onset ventricular tachycardia. New-onset ventricular tachycardia occurred in 2.6% of patients early after successful percutaneous coronary intervention for chronic total occlusion, with impaired left ventricular systolic function as the only independent predictor.
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