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Early mortality risk persists after ventricular tachycardia ablation
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A percentage of patients with scar-related ventricular tachycardia who underwent radiofrequency catheter ablation experienced early mortality, which may have been predicted by procedural and clinical outcomes, according to a study in the Journal of the American College of Cardiology.
“Our study systematically describes the occurrence of postprocedural [early mortality] in patients undergoing [radiofrequency catheter ablation] of scar-related [ventricular tachycardia], and it is essential for understanding the rates of in-hospital and early postdischarge mortality in this complex patient population, allowing for direct comparison with similar indicators developed for other interventional and surgical cardiac procedures,” Pasquale Santangeli, MD, PhD, assistant professor of medicine at the Hospital of the University of Pennsylvania in Philadelphia, and colleagues wrote.
Treatment for ventricular tachycardia
Researchers reviewed data from 2,061 patients (mean age, 62 years; mean left ventricular ejection fraction, 34 ± 13%; 87% men) who received radiofrequency catheter ablation between 2002 and 2013 in centers that specialize in ventricular tachycardia. Patients had structural heart disease, evidence of myocardial scar, radiofrequency catheter ablation for monomorphic ventricular tachycardia or clinical follow-up for the recurrence of ventricular tachycardia, mortality and transplant.
The primary endpoint was early postprocedural mortality within the first 31 days. Recurrent ventricular tachycardia or ventricular fibrillation were the secondary endpoints.
Early mortality occurred in 100 patients (5%; 95% CI, 4-6) after the procedure, of which 54 patients died before discharge an average of 9 days from the original ablation procedure. A major procedure-related complication was the cause of death for 12 patients (0.6%) who died in the hospital, including thromboembolic events, major bleeding events and procedural death.
Independent variables
Researchers utilized multivariable analysis, which determined that the following were independently associated with early mortality: chronic kidney disease (OR = 2.73; 95% CI, 1.1-6.8), LVEF (OR per percentage decrease = 1.12; 95% CI, 1.05-1.2), presence of unmappable ventricular tachycardia (OR = 5.69; 95% CI, 1.37-23.69) and presentation with ventricular tachycardia storm (OR = 3.61; 95% CI, 1.37-9.48). Recurrent ventricular tachycardia was linked to increased risk for subsequent death (HR = 7.19; 95% CI, 5.57-9.28) and early mortality (HR = 11.45; 95% CI, 7.47-17.59).
“These results highlight the importance of minimizing procedural-related complications as an important outcome of [ventricular tachycardia] ablation procedures, as this factor may have a potential favorable impact on subsequent mortality,” Santangeli and colleagues wrote. “Because complications tend to decline with operator and center experience, these data also suggest that these procedures should be performed in [ventricular tachycardia] ablation specialty centers as a means to further reduce [early mortality].”
In a related editorial, Frédéric Sacher, MD, PhD, from Universitaire de Bordeaux in France, and Ruairidh Martin, MD, from Universitaire de Bordeaux in France and Newcastle University in the United Kingdom, wrote: “Although we all strive to avoid deaths at the time of [ventricular tachycardia] ablation, we much also try to avoid unnecessary [ventricular tachycardia] ablation at the time of death. It is also important to consider the most appropriate timing for [ventricular tachycardia] ablation. [Ventricular tachycardia] ablation is still viewed by many physicians as a last resort treatment; however, ablation earlier in the course of the disease, when there are fewer comorbidities, may be associated with lower risk and improved outcome.” – by Darlene Dobkowski
Disclosure : Martin reports receiving a research grant from Boston Scientific. Sacher reports receiving speaking honorarium from Biosense Webster, Boston Scientific, Livanova, Medtronic and St. Jude Medical, and consultant fees from Biotronik, Boston Scientific and St. Jude Medical. Santangeli reports receiving honoraria from Baylis Medical, Biosense Webster, Boston Scientific and Medtronic, and consulting for Baylis Medical and Biosense Webster. Please see the full study for the other researchers’ relevant financial disclosures.
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