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Multicenter Study
. 2015 Sep;12(9):1997-2007.
doi: 10.1016/j.hrthm.2015.05.036. Epub 2015 May 30.

Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: An International VT Ablation Center Collaborative Group study

Roderick Tung  1 , Marmar Vaseghi  1 , David S Frankel  2 , Pasquale Vergara  3 , Luigi Di Biase  4 , Koichi Nagashima  5 , Ricky Yu  1 , Sitaram Vangala  6 , Chi-Hong Tseng  6 , Eue-Keun Choi  5 , Shaan Khurshid  2 , Mehul Patel  7 , Nilesh Mathuria  7 , Shiro Nakahara  8 , Wendy S Tzou  9 , William H Sauer  9 , Kairav Vakil  10 , Usha Tedrow  5 , J David Burkhardt  4 , Venkatakrishna N Tholakanahalli  10 , Anastasios Saliaris  11 , Timm Dickfeld  11 , J Peter Weiss  12 , T Jared Bunch  12 , Madhu Reddy  13 , Arun Kanmanthareddy  13 , David J Callans  2 , Dhanunjaya Lakkireddy  13 , Andrea Natale  4 , Francis Marchlinski  2 , William G Stevenson  5 , Paolo Della Bella  3 , Kalyanam Shivkumar  14
Affiliations
Multicenter Study

Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: An International VT Ablation Center Collaborative Group study

Roderick Tung et al. Heart Rhythm. 2015 Sep.

Abstract

Background: The impact of catheter ablation of ventricular tachycardia (VT) on all-cause mortality remains unknown.

Objective: The purpose of this study was to examine the association between VT recurrence after ablation and survival in patients with scar-related VT.

Methods: Analysis of 2061 patients with structural heart disease referred for catheter ablation of scar-related VT from 12 international centers was performed. Data on clinical and procedural variables, VT recurrence, and mortality were analyzed. Kaplan-Meier analysis was used to estimate freedom from recurrent VT, transplant, and death. Cox proportional hazards frailty models were used to analyze the effect of risk factors on VT recurrence and mortality.

Results: One-year freedom from VT recurrence was 70% (72% in ischemic and 68% in nonischemic cardiomyopathy). Fifty-seven patients (3%) underwent cardiac transplantation, and 216 (10%) died during follow-up. At 1 year, the estimated rate of transplant and/or mortality was 15% (same for ischemic and nonischemic cardiomyopathy). Transplant-free survival was significantly higher in patients without VT recurrence than in those with recurrence (90% vs 71%, P<.001). In multivariable analysis, recurrence of VT after ablation showed the highest risk for transplant and/or mortality [hazard ratio 6.9 (95% CI 5.3-9.0), P<.001]. In patients with ejection fraction <30% and across all New York Heart Association functional classes, improved transplant-free survival was seen in those without VT recurrence.

Conclusion: Catheter ablation of VT in patients with structural heart disease results in 70% freedom from VT recurrence, with an overall transplant and/or mortality rate of 15% at 1 year. Freedom from VT recurrence is associated with improved transplant-free survival, independent of heart failure severity.

Keywords: Ablation; Ventricular tachycardia.

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Figures

FIGURE 1
FIGURE 1
Kaplan-Meier estimate of freedom from VT in the overall cohort.
FIGURE 2
FIGURE 2
Kaplan-Meier estimate of VT and transplant-free survival in the overall cohort.
FIGURE 3
FIGURE 3
Kaplan-Meier display of transplant-free survival between patients with and without VT recurrence.
FIGURE 4
FIGURE 4
Hazard ratio plot of multivariable Cox proportional hazard regression for transplant/mortality and VT recurrence.
FIGURE 5
FIGURE 5
Kaplan-Meier display of transplant-free survival by VT recurrence in patients with EF greater and less than 30%.
FIGURE 6
FIGURE 6
Kaplan-Meier display of transplant-free survival by VT recurrence in in patients by NYHA class.
See this image and copyright information in PMC

Comment in

References

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