Clinical Trial

. 2024 Mar 30;26(4):euae066.

doi: 10.1093/europace/euae066.

Impact of ventricular tachycardia ablation in subcutaneous implantable cardioverter defibrillator carriers: a multicentre, international analysis from the iSUSI project

Marco Schiavone^{1

2}, Alessio Gasperetti^{3

4}, Paolo Compagnucci⁵, Julia Vogler⁶, Mikael Laredo⁷, Elisabetta Montemerlo⁸, Simone Gulletta⁹, Alexander Breitenstein¹⁰, Matteo Ziacchi¹¹, Martin Martinek¹², Michela Casella⁵, Pietro Palmisano¹³, Lukas Kaiser¹⁴, Carlo Lavalle¹⁵, Leonardo Calò¹⁶, Sebastian Seidl¹², Ardan M Saguner¹⁰, Giovanni Rovaris⁸, Jürgen Kuschyk¹⁷, Mauro Biffi¹¹, Luigi Di Biase¹⁸, Antonio Dello Russo⁵, Claudio Tondo^{1

19}, Paolo Della Bella⁹, Roland Tilz⁶, Giovanni B Forleo³; iSUSI investigators

Collaborators, Affiliations

Collaborators

iSUSI investigators:
M Schiavone, A Gasperetti, R Arosio, M Viecca, G B Forleo, M Ziacchi, I Diemberger, A Angeletti, M Biffi, N Fierro, S Gulletta, P Della Bella, C Tondo, G Mitacchione, A Curnis, P Compagnucci, M Casella, A Dello Russo, L Santini, C Pignalberi, M Magnocavallo, A Piro, C Lavalle, F Picarelli, D Ricciardi, E Bressi, L Calò, E Montemerlo, G Rovaris, S De Bonis, A Bisignani, G Bisignani, G Russo, E Pisanò, P Palmisano, F Guarracini, F Vitali, M Bertini, J Vogler, T Fink, R Tilz, F Fastenrath, J Kuschyk, L Kaiser, S Hakmi, M Laredo, X Waintraub, E Gandjbakhch, N Badenco, A Breitenstein, A M Saguner, M Martine, S Seidl, L Di Biase

Affiliations

¹ Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
² Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
³ Cardiology Unit, Luigi Sacco University Hospital, Via Giovanni Battista Grassi, 74, Milan 20157, Italy.
⁴ Department of Cardiology, Johns Hopkins University, 1800 Orleans Street, Baltimore, MD 21218, USA.
⁵ Cardiology and Arrhythmology Clinic, University Hospital 'Ospedali Riuniti', Ancona, Italy.
⁶ Department of Rhythmology, University Heart Center Lübeck, Lubeck, Germany.
⁷ Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière and Sorbonne Université, Paris, France.
⁸ Cardiology Unit, ASST Monza, San Gerardo Hospital, Monza, Italy.
⁹ Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy.
¹⁰ Cardiology Clinic, University Hospital Zurich, Zurich, Switzerland.
¹¹ Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy.
¹² Internal Medicine 2 with Cardiology, Angiology, and Intensive Care Medicine, Ordensklinikum Linz Elisabethinen, Linz, Austria.
¹³ Cardiology Unit, 'Card. G. Panico' Hospital, Tricase, Italy.
¹⁴ Department of Cardiology and Critical Care Medicine, St. George Klinik Asklepios, Hamburg, Germany.
¹⁵ Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
¹⁶ Department of Cardiology, Policlinico Casilino, Rome, Italy.
¹⁷ Cardiology Unit, University Medical Centre Mannheim, Manheim, Germany.
¹⁸ Cardiac Arrhythmia Center, Division of Cardiology, Montefiore-Einstein Center, Bronx, NY, USA.
¹⁹ Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.

PMID: 38584394
PMCID: PMC10999646
DOI: 10.1093/europace/euae066

Clinical Trial

Impact of ventricular tachycardia ablation in subcutaneous implantable cardioverter defibrillator carriers: a multicentre, international analysis from the iSUSI project

Marco Schiavone et al. Europace. 2024.

. 2024 Mar 30;26(4):euae066.

doi: 10.1093/europace/euae066.

Authors

Collaborators

iSUSI investigators:
M Schiavone, A Gasperetti, R Arosio, M Viecca, G B Forleo, M Ziacchi, I Diemberger, A Angeletti, M Biffi, N Fierro, S Gulletta, P Della Bella, C Tondo, G Mitacchione, A Curnis, P Compagnucci, M Casella, A Dello Russo, L Santini, C Pignalberi, M Magnocavallo, A Piro, C Lavalle, F Picarelli, D Ricciardi, E Bressi, L Calò, E Montemerlo, G Rovaris, S De Bonis, A Bisignani, G Bisignani, G Russo, E Pisanò, P Palmisano, F Guarracini, F Vitali, M Bertini, J Vogler, T Fink, R Tilz, F Fastenrath, J Kuschyk, L Kaiser, S Hakmi, M Laredo, X Waintraub, E Gandjbakhch, N Badenco, A Breitenstein, A M Saguner, M Martine, S Seidl, L Di Biase

Affiliations

¹ Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
² Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
³ Cardiology Unit, Luigi Sacco University Hospital, Via Giovanni Battista Grassi, 74, Milan 20157, Italy.
⁴ Department of Cardiology, Johns Hopkins University, 1800 Orleans Street, Baltimore, MD 21218, USA.
⁵ Cardiology and Arrhythmology Clinic, University Hospital 'Ospedali Riuniti', Ancona, Italy.
⁶ Department of Rhythmology, University Heart Center Lübeck, Lubeck, Germany.
⁷ Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière and Sorbonne Université, Paris, France.
⁸ Cardiology Unit, ASST Monza, San Gerardo Hospital, Monza, Italy.
⁹ Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy.
¹⁰ Cardiology Clinic, University Hospital Zurich, Zurich, Switzerland.
¹¹ Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy.
¹² Internal Medicine 2 with Cardiology, Angiology, and Intensive Care Medicine, Ordensklinikum Linz Elisabethinen, Linz, Austria.
¹³ Cardiology Unit, 'Card. G. Panico' Hospital, Tricase, Italy.
¹⁴ Department of Cardiology and Critical Care Medicine, St. George Klinik Asklepios, Hamburg, Germany.
¹⁵ Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
¹⁶ Department of Cardiology, Policlinico Casilino, Rome, Italy.
¹⁷ Cardiology Unit, University Medical Centre Mannheim, Manheim, Germany.
¹⁸ Cardiac Arrhythmia Center, Division of Cardiology, Montefiore-Einstein Center, Bronx, NY, USA.
¹⁹ Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.

PMID: 38584394
PMCID: PMC10999646
DOI: 10.1093/europace/euae066

Abstract

Aims: Catheter ablation (CA) of ventricular tachycardia (VT) has become an important tool to improve clinical outcomes in patients with appropriate transvenous implantable cardioverter defibrillator (ICD) shocks. The aim of our analysis was to test whether VT ablation (VTA) impacts long-term clinical outcomes even in subcutaneous ICD (S-ICD) carriers.

Methods and results: International Subcutaneous Implantable Cardioverter Defibrillator (iSUSI) registry patients who experienced either an ICD shock or a hospitalization for monomorphic VT were included in this analysis. Based on an eventual VTA after the index event, patients were divided into VTA+ vs. VTA- cohorts. Primary outcome of the study was the occurrence of a combination of device-related appropriate shocks, monomorphic VTs, and cardiovascular mortality. Secondary outcomes were addressed individually. Among n = 1661 iSUSI patients, n = 211 were included: n = 177 experiencing ICD shocks and n = 34 hospitalized for VT. No significant differences in baseline characteristics were observed. Both the crude and the yearly event rate of the primary outcome (5/59 and 3.8% yearly event rate VTA+ vs. 41/152 and 16.4% yearly event rate in the VTA-; log-rank: P value = 0.0013) and the cardiovascular mortality (1/59 and 0.7% yearly event rate VTA+ vs. 13/152 and 4.7% yearly event rate VTA-; log-rank P = 0.043) were significantly lower in the VTA + cohort. At multivariate analysis, VTA was the only variable remaining associated with a lower incidence of the primary outcome [adjusted hazard ratio 0.262 (0.100-0.681), P = 0.006].

Conclusion: In a real-world registry of S-ICD carriers, the combined study endpoint of arrhythmic events and cardiovascular mortality was lower in the patient cohort undergoing VTA at long-term follow-up.

Clinicaltrials.gov identifier: NCT0473876.

Trial registration: ClinicalTrials.gov NCT00473876.

Keywords: Arrhythmic mortality; Catheter ablation; Defibrillator; Subcutaneous ICD; Ventricular tachycardia.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: A.D.R. is a consultant for Abbott. M.C. has received speaker honoraria from Abbott and Biosense Webster. L.K. worked as a proctor for Boston Scientific. R.T. is a consultant for Boston Scientific, Biotronik, Biosense Webster, Abbott Medical, and he received speaker’s honoraria from Boston Scientific, Biotronik, Biosense Webster, Abbott Medical, and LifeTech and research grants from Abbott, Biosense Webster, and LifeTech. A.B. has received consultant and/or speaker fees from Abbott, Bayer Healthcare, Biosense Webster, Biotronik, Boston Scientific, Bristol Myers Squibb, Cook Medical, Daiichi Sankyo, Medtronic, Pfizer, and Spectranetics/Philips.

Figures

**Figure 1**
Flowchart summarizing the workflow resulting in the two final cohorts.

**Figure 2**
Changes in pre- (upper end)/post- (lower end) ventricular tachycardia (VT) event rates at individual patient level. ‘X’ indicates a pre-ventricular tachycardia ablation (VTA) rate capping at 15 for graphical reasons.

**Figure 3**
Kaplan–Meier curves for the primary outcome of interest. Red: patients undergoing ventricular tachycardia ablation (VTA+ cohort). Blue: patients not undergoing ventricular tachycardia ablation (VTA− cohort).

See this image and copyright information in PMC

References

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1. Natale A, Zeppenfeld K, Della Bella P, Liu X, Sabbag A, Santangeli Pe et al. Twenty-five years of catheter ablation of ventricular tachycardia: a look back and a look forward. Europace 2023;25:euad225. - PMC - PubMed

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Impact of ventricular tachycardia ablation in subcutaneous implantable cardioverter defibrillator carriers: a multicentre, international analysis from the iSUSI project

Collaborators

Affiliations

Impact of ventricular tachycardia ablation in subcutaneous implantable cardioverter defibrillator carriers: a multicentre, international analysis from the iSUSI project

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

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References

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