Catheter ablation for structural heart disease ventricular tachycardia was associated with a higher major complication rate compared to idiopathic VT (8.0% vs 2.8%; P=0.006).
Cohort (n=548)
No
What are the incidence and predictors of major complications associated with catheter ablation for ventricular tachycardia?
Catheter ablation for ventricular tachycardia carries a 6.2% major complication rate, with higher risks in structural heart disease, electrical storm, and non-elective procedures, driven independently by age, renal function, and operator.
Absolute Event Rate: 8% vs 2.8%
p-value: p=0.006
BACKGROUND: Catheter ablation has become an established treatment modality for a broad spectrum of ventricular tachycardias (VTs). We analyzed incidence and predictors of major complications of VT ablation procedures in a high-volume expert center. METHODS AND RESULTS: We evaluated 548 consecutive patients who underwent 722 ablation procedures, 473 (65.5%) for structural heart disease VT in the period 2006 to 2012. There were 45 (6.2%) major complications observed in 44 patients. Access site vascular complications were the most frequent (3.6%). Three patients (0.4%) had cardiac tamponade/hemopericardium, and 5 patients (0.7%) had a thromboembolic event. No procedural deaths occurred. Procedures for structural heart disease VT versus idiopathic VT had a significantly higher complication rate (8.0% versus 2.8%; P=0.006). Similarly, patients with electrical storm (10.1% versus 5.3%; P=0.04) and nonelective procedures (8.4% versus 3.5%; P=0.007) were at higher risk of complications. On multivariate analysis, age >70 years (P=0.01), serum creatinine >115 μmol/L (P=0.0003), and individual operator (P=0.0001) were the only independent predictors of complications. Overall 30-day mortality in the structural heart disease VT group reached 5.0% (patients) and 3.6% (procedures). Death was associated with early recurrence of VT/ventricular fibrillation (P=0.003) and ablation for electrical storm (P=0.02). CONCLUSIONS: Complication rates for VT ablation are significantly lower in idiopathic VT or in elective procedures. Independent predictors of complications include age, renal insufficiency, and individual operator. Postprocedural mortality is predicted by early recurrence of VT/ventricular fibrillation and ablation for electrical storm.
Peichl et al. (Tue,) conducted a cohort in Ventricular tachycardia (n=548). Catheter ablation for structural heart disease VT vs. Catheter ablation for idiopathic VT was evaluated on Major complications (p=0.006). Catheter ablation for structural heart disease ventricular tachycardia was associated with a higher major complication rate compared to idiopathic VT (8.0% vs 2.8%; P=0.006).