Risk scores predict outcomes after ventricular tachycardia ablation

SAN FRANCISCO — Two risk scores accurately predicted adverse outcomes after ventricular tachycardia ablation in patients with nonischemic cardiomyopathy, according to findings presented at the Heart Rhythm Society Annual Scientific Sessions.

Simon A. Castro, MD, and Daniele Muser, MD, from the Hospital of the University of Pennsylvania, and colleagues evaluated eight preprocedural risk stratification approaches in 282 patients (mean age, 59 years; 80% men; mean left ventricular ejection fraction, 36%) with nonischemic cardiomyopathy undergoing catheter ablation for ventricular tachycardia.

“The efficacy of [ventricular tachycardia] ablation in patients with [nonischemic cardiomyopathy] is suboptimal, with postprocedural recurrence rates varying from 29% to 60%,” Muser and colleagues wrote in a simultaneous publication in JACC Electrophysiology. “On these premises, a proper preprocedural risk stratification ... is crucial.”

The outcomes of interest were death/cardiac transplantation and ventricular tachycardia recurrence. Median follow-up was 48 months.

The eight risk scores evaluated were SHFM, MAGGIC, ADHERE, EFFECT, OPTIMIZE-HF, CHARM, EuroSCORE and PAINESD.

During the study period, 15% of patients died, 9% required a heart transplant and 21% had ventricular tachycardia recurrence, according to the researchers.

Castro and colleagues found that two risk scores, SHFM and PAINESD, significantly outperformed the others in predicting the outcomes of interest.

For death/transplantation, the area under the receiver operator curve was 0.89 (goodness-of-fit P = .68) for SHFM and 0.83 (goodness-of-fit P = .24) for PAINESD, whereas for ventricular tachycardia recurrence, it was 0.77 (goodness-of-fit P = .16) for SHFM and 0.68 (goodness-of-fit P = .58) for PAINESD, according to the researchers.

“The implementation of these risk stratification tools can help identify the optimal therapeutic pathways beyond treatment of [ventricular tachycardia], such as earlier consideration for advanced HF therapies and/or proper discussion with patients and families about the expected procedural outcomes and goals of care,” the researchers wrote in JACC Electrophysiology. – by Erik Swain

References:

Castro SA, et al. Abstract S-PO02-169. Presented at: Heart Rhythm Society Annual Scientific Sessions; May 8-11, 2019; San Francisco.

Muser D, et al. JACC Electrophysiol. 2019;doi:10.1016/j.jacep.2019.04.001.

Disclosures: Castro and Muser report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.