Radiofrequency catheter ablation of ventricular tachycardia in patients with structural heart disease – single-center outcomes in a ten year period

    Authors

    Keywords

    catheter ablation, structural heart disease, predictors of recurrence, predictors of mortality, ventricular tachycardia

    DOI

    https://doi.org/10.15836/ccar2023.283

    Full Text

    **Background**: Ventricular tachycardia (VT) commonly occurs in patients with structural heart disease, either of ischemic or non-ischemic nature. Treatment options include various antiarrhythmic drugs (AADs) and implantable cardioverter-defibrillators (ICDs). When AADs fail, radiofrequency (RF) catheter ablation is a valuable treatment option for patients with recurrent VT. (1) This single-center ten-year retrospective study aimed to assess acute and chronic success rates of RF catheter ablation and to identify predictors of VT recurrence and patient survival. **Patients and Methods**: We analyzed all consecutive patients with structural heart disease who underwent RF catheter ablation of VT in our institution from 2011 to 2021. Data were collected from existing hospital electronic medical records. **Results**: A total of 72 patients (89% male, mean age 62 years, 28% with non-ischemic cardiomyopathy, mean LVEF 35%) were included. Non-inducibility was achieved in 64.7% of cases. One year VT recurrence rate was 41.6%. Substrate ablation significantly reduced the frequency of ICD shocks (14% vs. 60%, p = 0.001). The overall one-year survival was 86%. In multivariate analysis, VT inducibility was an independent predictor of VT recurrence (p = 0.02; OR = 13.5; 95% CI = 1.46-124.7). Female gender was an independent negative risk factor for patient survival (p = 0.03; OR = 7.19; 95% CI = 1.22-42.6). **Conclusion**: Our data show that RF catheter ablation of VT can be a feasible treatment option for patients with frequent AAD-refractory VTs with acceptable acute and chronic success rates, even in mid-volume centers like ours. VT ablation can reduce the frequency of ICD shocks and improve patients’ quality of life. Institutional registry can help monitor and improve outcomes and provide valuable feedback.

    Literature

    1. Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022 October 21;43(40):3997–4126. https://doi.org/10.1093/eurheartj/ehac262
    Cardiologia Croatica
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    Radiofrequency catheter ablation of ventricular tachycardia in patients with structural heart disease – single-center outcomes in a ten year period

    Extended Abstract
    Issue11-12
    Published
    Pages283
    PDF via DOIhttps://doi.org/10.15836/ccar2023.283
    catheter ablation
    structural heart disease
    predictors of recurrence
    predictors of mortality
    ventricular tachycardia

    Authors

    Vedran Pašara*ORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Luka PerčinORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Ivan PrepolecORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Borka Pezo-NikolićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Davor PuljevićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Davor MiličićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Vedran VelagićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

    *Correspondence email: vedran.pasara@gmail.com

    Full Text

    Background: Ventricular tachycardia (VT) commonly occurs in patients with structural heart disease, either of ischemic or non-ischemic nature. Treatment options include various antiarrhythmic drugs (AADs) and implantable cardioverter-defibrillators (ICDs). When AADs fail, radiofrequency (RF) catheter ablation is a valuable treatment option for patients with recurrent VT. (1) This single-center ten-year retrospective study aimed to assess acute and chronic success rates of RF catheter ablation and to identify predictors of VT recurrence and patient survival.

    Patients and Methods: We analyzed all consecutive patients with structural heart disease who underwent RF catheter ablation of VT in our institution from 2011 to 2021. Data were collected from existing hospital electronic medical records.

    Results: A total of 72 patients (89% male, mean age 62 years, 28% with non-ischemic cardiomyopathy, mean LVEF 35%) were included. Non-inducibility was achieved in 64.7% of cases. One year VT recurrence rate was 41.6%. Substrate ablation significantly reduced the frequency of ICD shocks (14% vs. 60%, p = 0.001). The overall one-year survival was 86%. In multivariate analysis, VT inducibility was an independent predictor of VT recurrence (p = 0.02; OR = 13.5; 95% CI = 1.46-124.7). Female gender was an independent negative risk factor for patient survival (p = 0.03; OR = 7.19; 95% CI = 1.22-42.6).

    Conclusion: Our data show that RF catheter ablation of VT can be a feasible treatment option for patients with frequent AAD-refractory VTs with acceptable acute and chronic success rates, even in mid-volume centers like ours. VT ablation can reduce the frequency of ICD shocks and improve patients’ quality of life. Institutional registry can help monitor and improve outcomes and provide valuable feedback.

    Literature

    1. 1.
      Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022 October 21;43(40):3997–4126.DOI