Trends and Outcomes of Catheter Ablation for Ventricular Tachycardia in a Community Cohort

Omair K. Yousuf, Robbert Zusterzeel, William Sanders, Daniel Caños, Carmen Dekmezian, Henry Silverman, Hugh Calkins, Ronald D Berger, Harikrishna Tandri, Saman Nazarian, David G. Strauss

Research output: Contribution to journalArticle

Abstract

Objectives: This study examined the trend in growth of catheter ablation for ventricular tachycardia (VT) performed in the United States with analysis of rates and predictors of major adverse events. Background: Sustained VT is a significant cause of sudden death, heart failure (HF), and recurrent shocks in implantable cardioverter-defibrillator (ICD) recipients. Catheter ablation for VT reduces arrhythmia recurrence. Limited data are available regarding the use, safety, and long-term outcomes after VT ablation. Methods: Using the U.S. Medicare database linked to the Social Security Death Index, we examined the annual use of VT ablation in 21,073 patients over 12 years, with 30-day risk of mortality, nonfatal major adverse events (MAEs), 1-year risk of mortality, re-hospitalization, repeat ablation, and factors associated with adverse outcomes. Results: Among 21,073 patients (age 70 ± 9 years; 77% men; 90% white), there were 1,581 (7.5%) non-fatal MAEs within 30 days. There were 963 (4.6%) vascular complications, 485 (2.3%) pericardial complications, and 201 (1%) strokes and/or transient ischemic attacks. Mechanical circulatory support use was infrequent (2.3%). The 30-day and 1-year mortality rates were 4.2% and 15.0%, respectively. The 1-year incidence of repeat ablation was 10.2 per 100 person-years and re-hospitalization for HF or VT was 15.4 per 100 person-years and 18 per 100 person-years, respectively. Patients with an ICD had increased 30-day (4.9% vs. 0.86%) and 1-year mortality (17.5% vs. 2.54% [22.9 per 100 person-years vs. 3.1 per 100 person-years]; hazard ratio [HR]: 2.93; 95% confidence interval [CI]: 2.21 to 3.88). Rates of hospitalization for HF (18 per 100 person-years vs. 1.8 per 100 person-years; HR: 4.00; 95% CI: 2.78 to 5.78) or VT recurrence (22.7 per 100 person-years vs. 2.1 per 100 person-years; HR: 5.70; 95% CI: 4.09 to 7.96) were also higher at 1 year. Between 2000 and 2012, annual VT ablation volumes increased >4-fold. Conclusions: Catheter ablation for VT is frequently performed. Short-term MAEs and 1-year mortality is significant and is highest in patients with an ICD. These findings may provide greater insight of outcomes in an unselected real-world population undergoing VT ablation.

Original languageEnglish (US)
Pages (from-to)1189-1199
Number of pages11
JournalJACC: Clinical Electrophysiology
Volume4
Issue number9
DOIs
StatePublished - Sep 1 2018

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Catheter Ablation
Ventricular Tachycardia
Implantable Defibrillators
Mortality
Hospitalization
Heart Failure
Confidence Intervals
Recurrence
Social Security
Transient Ischemic Attack
Medicare
Sudden Death
Blood Vessels
Cardiac Arrhythmias
Cause of Death
Shock
Stroke
Databases
Safety

Keywords

  • cardiomyopathy
  • catheter ablation
  • ICD
  • sudden cardiac death
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Yousuf, O. K., Zusterzeel, R., Sanders, W., Caños, D., Dekmezian, C., Silverman, H., ... Strauss, D. G. (2018). Trends and Outcomes of Catheter Ablation for Ventricular Tachycardia in a Community Cohort. JACC: Clinical Electrophysiology, 4(9), 1189-1199. https://doi.org/10.1016/j.jacep.2018.06.020

Trends and Outcomes of Catheter Ablation for Ventricular Tachycardia in a Community Cohort. / Yousuf, Omair K.; Zusterzeel, Robbert; Sanders, William; Caños, Daniel; Dekmezian, Carmen; Silverman, Henry; Calkins, Hugh; Berger, Ronald D; Tandri, Harikrishna; Nazarian, Saman; Strauss, David G.

In: JACC: Clinical Electrophysiology, Vol. 4, No. 9, 01.09.2018, p. 1189-1199.

Research output: Contribution to journalArticle

Yousuf, OK, Zusterzeel, R, Sanders, W, Caños, D, Dekmezian, C, Silverman, H, Calkins, H, Berger, RD, Tandri, H, Nazarian, S & Strauss, DG 2018, 'Trends and Outcomes of Catheter Ablation for Ventricular Tachycardia in a Community Cohort', JACC: Clinical Electrophysiology, vol. 4, no. 9, pp. 1189-1199. https://doi.org/10.1016/j.jacep.2018.06.020
Yousuf, Omair K. ; Zusterzeel, Robbert ; Sanders, William ; Caños, Daniel ; Dekmezian, Carmen ; Silverman, Henry ; Calkins, Hugh ; Berger, Ronald D ; Tandri, Harikrishna ; Nazarian, Saman ; Strauss, David G. / Trends and Outcomes of Catheter Ablation for Ventricular Tachycardia in a Community Cohort. In: JACC: Clinical Electrophysiology. 2018 ; Vol. 4, No. 9. pp. 1189-1199.
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abstract = "Objectives: This study examined the trend in growth of catheter ablation for ventricular tachycardia (VT) performed in the United States with analysis of rates and predictors of major adverse events. Background: Sustained VT is a significant cause of sudden death, heart failure (HF), and recurrent shocks in implantable cardioverter-defibrillator (ICD) recipients. Catheter ablation for VT reduces arrhythmia recurrence. Limited data are available regarding the use, safety, and long-term outcomes after VT ablation. Methods: Using the U.S. Medicare database linked to the Social Security Death Index, we examined the annual use of VT ablation in 21,073 patients over 12 years, with 30-day risk of mortality, nonfatal major adverse events (MAEs), 1-year risk of mortality, re-hospitalization, repeat ablation, and factors associated with adverse outcomes. Results: Among 21,073 patients (age 70 ± 9 years; 77{\%} men; 90{\%} white), there were 1,581 (7.5{\%}) non-fatal MAEs within 30 days. There were 963 (4.6{\%}) vascular complications, 485 (2.3{\%}) pericardial complications, and 201 (1{\%}) strokes and/or transient ischemic attacks. Mechanical circulatory support use was infrequent (2.3{\%}). The 30-day and 1-year mortality rates were 4.2{\%} and 15.0{\%}, respectively. The 1-year incidence of repeat ablation was 10.2 per 100 person-years and re-hospitalization for HF or VT was 15.4 per 100 person-years and 18 per 100 person-years, respectively. Patients with an ICD had increased 30-day (4.9{\%} vs. 0.86{\%}) and 1-year mortality (17.5{\%} vs. 2.54{\%} [22.9 per 100 person-years vs. 3.1 per 100 person-years]; hazard ratio [HR]: 2.93; 95{\%} confidence interval [CI]: 2.21 to 3.88). Rates of hospitalization for HF (18 per 100 person-years vs. 1.8 per 100 person-years; HR: 4.00; 95{\%} CI: 2.78 to 5.78) or VT recurrence (22.7 per 100 person-years vs. 2.1 per 100 person-years; HR: 5.70; 95{\%} CI: 4.09 to 7.96) were also higher at 1 year. Between 2000 and 2012, annual VT ablation volumes increased >4-fold. Conclusions: Catheter ablation for VT is frequently performed. Short-term MAEs and 1-year mortality is significant and is highest in patients with an ICD. These findings may provide greater insight of outcomes in an unselected real-world population undergoing VT ablation.",
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T1 - Trends and Outcomes of Catheter Ablation for Ventricular Tachycardia in a Community Cohort

AU - Yousuf, Omair K.

AU - Zusterzeel, Robbert

AU - Sanders, William

AU - Caños, Daniel

AU - Dekmezian, Carmen

AU - Silverman, Henry

AU - Calkins, Hugh

AU - Berger, Ronald D

AU - Tandri, Harikrishna

AU - Nazarian, Saman

AU - Strauss, David G.

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Objectives: This study examined the trend in growth of catheter ablation for ventricular tachycardia (VT) performed in the United States with analysis of rates and predictors of major adverse events. Background: Sustained VT is a significant cause of sudden death, heart failure (HF), and recurrent shocks in implantable cardioverter-defibrillator (ICD) recipients. Catheter ablation for VT reduces arrhythmia recurrence. Limited data are available regarding the use, safety, and long-term outcomes after VT ablation. Methods: Using the U.S. Medicare database linked to the Social Security Death Index, we examined the annual use of VT ablation in 21,073 patients over 12 years, with 30-day risk of mortality, nonfatal major adverse events (MAEs), 1-year risk of mortality, re-hospitalization, repeat ablation, and factors associated with adverse outcomes. Results: Among 21,073 patients (age 70 ± 9 years; 77% men; 90% white), there were 1,581 (7.5%) non-fatal MAEs within 30 days. There were 963 (4.6%) vascular complications, 485 (2.3%) pericardial complications, and 201 (1%) strokes and/or transient ischemic attacks. Mechanical circulatory support use was infrequent (2.3%). The 30-day and 1-year mortality rates were 4.2% and 15.0%, respectively. The 1-year incidence of repeat ablation was 10.2 per 100 person-years and re-hospitalization for HF or VT was 15.4 per 100 person-years and 18 per 100 person-years, respectively. Patients with an ICD had increased 30-day (4.9% vs. 0.86%) and 1-year mortality (17.5% vs. 2.54% [22.9 per 100 person-years vs. 3.1 per 100 person-years]; hazard ratio [HR]: 2.93; 95% confidence interval [CI]: 2.21 to 3.88). Rates of hospitalization for HF (18 per 100 person-years vs. 1.8 per 100 person-years; HR: 4.00; 95% CI: 2.78 to 5.78) or VT recurrence (22.7 per 100 person-years vs. 2.1 per 100 person-years; HR: 5.70; 95% CI: 4.09 to 7.96) were also higher at 1 year. Between 2000 and 2012, annual VT ablation volumes increased >4-fold. Conclusions: Catheter ablation for VT is frequently performed. Short-term MAEs and 1-year mortality is significant and is highest in patients with an ICD. These findings may provide greater insight of outcomes in an unselected real-world population undergoing VT ablation.

AB - Objectives: This study examined the trend in growth of catheter ablation for ventricular tachycardia (VT) performed in the United States with analysis of rates and predictors of major adverse events. Background: Sustained VT is a significant cause of sudden death, heart failure (HF), and recurrent shocks in implantable cardioverter-defibrillator (ICD) recipients. Catheter ablation for VT reduces arrhythmia recurrence. Limited data are available regarding the use, safety, and long-term outcomes after VT ablation. Methods: Using the U.S. Medicare database linked to the Social Security Death Index, we examined the annual use of VT ablation in 21,073 patients over 12 years, with 30-day risk of mortality, nonfatal major adverse events (MAEs), 1-year risk of mortality, re-hospitalization, repeat ablation, and factors associated with adverse outcomes. Results: Among 21,073 patients (age 70 ± 9 years; 77% men; 90% white), there were 1,581 (7.5%) non-fatal MAEs within 30 days. There were 963 (4.6%) vascular complications, 485 (2.3%) pericardial complications, and 201 (1%) strokes and/or transient ischemic attacks. Mechanical circulatory support use was infrequent (2.3%). The 30-day and 1-year mortality rates were 4.2% and 15.0%, respectively. The 1-year incidence of repeat ablation was 10.2 per 100 person-years and re-hospitalization for HF or VT was 15.4 per 100 person-years and 18 per 100 person-years, respectively. Patients with an ICD had increased 30-day (4.9% vs. 0.86%) and 1-year mortality (17.5% vs. 2.54% [22.9 per 100 person-years vs. 3.1 per 100 person-years]; hazard ratio [HR]: 2.93; 95% confidence interval [CI]: 2.21 to 3.88). Rates of hospitalization for HF (18 per 100 person-years vs. 1.8 per 100 person-years; HR: 4.00; 95% CI: 2.78 to 5.78) or VT recurrence (22.7 per 100 person-years vs. 2.1 per 100 person-years; HR: 5.70; 95% CI: 4.09 to 7.96) were also higher at 1 year. Between 2000 and 2012, annual VT ablation volumes increased >4-fold. Conclusions: Catheter ablation for VT is frequently performed. Short-term MAEs and 1-year mortality is significant and is highest in patients with an ICD. These findings may provide greater insight of outcomes in an unselected real-world population undergoing VT ablation.

KW - cardiomyopathy

KW - catheter ablation

KW - ICD

KW - sudden cardiac death

KW - ventricular tachycardia

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