Ventricular Tachycardia Ablation in Severe Heart Failure: An International Ventricular Tachycardia Ablation Center Collaboration Analysis

Wendy S. Tzou, Roderick Tung, David S. Frankel, Marmar Vaseghi, T. Jared Bunch, Luigi Di Biase, Venkatakrishna N. Tholakanahalli, Dhanunjaya Lakkireddy, Timm Dickfeld, Anastasios Saliaris, J. Peter Weiss, Nilesh Mathuria, Usha Tedrow, Mohammed R. Afzal, Pasquale Vergara, Koichi Nagashima, Mehul Patel, Shiro Nakahara, Kairav Vakil, J. David BurkhardtChi Hong Tseng, Andrea Natale, Kalyanam Shivkumar, David J. Callans, William G. Stevenson, Paolo Della Bella, Francis E. Marchlinski, William H. Sauer

Research output: Contribution to journalArticle

Abstract

Background - Ventricular tachycardia (VT) radiofrequency ablation has been associated with reduced VT recurrence and mortality, although it is typically not considered among New York Heart Association class IV (NYHA IV) heart failure patients. We compared characteristics and VT radiofrequency ablation outcomes of those with and without NYHA IV in the International VT Ablation Center Collaboration. Methods and Results - NYHA II-IV patients undergoing VT radiofrequency ablation at 12 international centers were included. Clinical variables, VT recurrence, and mortality were analyzed by NYHA IV status using Kaplan-Meier analysis and Cox proportional hazard models. There were significant differences between NYHA IV (n=111) and NYHA II and III (n=1254) patients: NYHA IV had lower left ventricular ejection fraction; more had diabetes mellitus, kidney disease, cardiac resynchronization implantable cardioverter-defibrillator, and VT storm despite greater antiarrhythmic drug use (P<0.01). NYHA IV subjects required more hemodynamic support, were inducible for more and slower VTs, and were less likely to undergo final programmed stimulation. There was no significant difference in acute complications. In-hospital deaths, recurrent VT, and 1-year mortality were higher in the NYHA IV group, in the context of greater baseline comorbidities. Importantly, NYHA IV patients without recurrent VT had similar survival compared with NYHA II and III patients with recurrent VT (68% versus 73%). Early VT recurrence (≤30 days) was significantly associated with mortality, especially in NYHA IV patients. Conclusions - Despite greater baseline comorbidities, VT radiofrequency ablation can be safely performed among NYHA IV patients. Early VT recurrence is significantly associated with subsequent mortality regardless of NYHA status. Elimination of recurrent VT in NYHA IV patients may reduce mortality to a level comparable to NYHA II and III with arrhythmia recurrence.

Original languageEnglish (US)
Article numbere004494
JournalCirculation: Arrhythmia and Electrophysiology
Volume10
Issue number1
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

Fingerprint

Ventricular Tachycardia
Heart Failure
Mortality
Recurrence
Comorbidity
Cardiac Resynchronization Therapy
Implantable Defibrillators
Anti-Arrhythmia Agents
Kaplan-Meier Estimate
Kidney Diseases
Proportional Hazards Models
Stroke Volume
Cardiac Arrhythmias
Diabetes Mellitus
Hemodynamics

Keywords

  • catheter ablation
  • heart failure
  • tachycardia, ventricular

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Ventricular Tachycardia Ablation in Severe Heart Failure : An International Ventricular Tachycardia Ablation Center Collaboration Analysis. / Tzou, Wendy S.; Tung, Roderick; Frankel, David S.; Vaseghi, Marmar; Jared Bunch, T.; Di Biase, Luigi; Tholakanahalli, Venkatakrishna N.; Lakkireddy, Dhanunjaya; Dickfeld, Timm; Saliaris, Anastasios; Peter Weiss, J.; Mathuria, Nilesh; Tedrow, Usha; Afzal, Mohammed R.; Vergara, Pasquale; Nagashima, Koichi; Patel, Mehul; Nakahara, Shiro; Vakil, Kairav; David Burkhardt, J.; Tseng, Chi Hong; Natale, Andrea; Shivkumar, Kalyanam; Callans, David J.; Stevenson, William G.; Della Bella, Paolo; Marchlinski, Francis E.; Sauer, William H.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 10, No. 1, e004494, 01.01.2017.

Research output: Contribution to journalArticle

Tzou, WS, Tung, R, Frankel, DS, Vaseghi, M, Jared Bunch, T, Di Biase, L, Tholakanahalli, VN, Lakkireddy, D, Dickfeld, T, Saliaris, A, Peter Weiss, J, Mathuria, N, Tedrow, U, Afzal, MR, Vergara, P, Nagashima, K, Patel, M, Nakahara, S, Vakil, K, David Burkhardt, J, Tseng, CH, Natale, A, Shivkumar, K, Callans, DJ, Stevenson, WG, Della Bella, P, Marchlinski, FE & Sauer, WH 2017, 'Ventricular Tachycardia Ablation in Severe Heart Failure: An International Ventricular Tachycardia Ablation Center Collaboration Analysis', Circulation: Arrhythmia and Electrophysiology, vol. 10, no. 1, e004494. https://doi.org/10.1161/CIRCEP.116.004494
Tzou, Wendy S. ; Tung, Roderick ; Frankel, David S. ; Vaseghi, Marmar ; Jared Bunch, T. ; Di Biase, Luigi ; Tholakanahalli, Venkatakrishna N. ; Lakkireddy, Dhanunjaya ; Dickfeld, Timm ; Saliaris, Anastasios ; Peter Weiss, J. ; Mathuria, Nilesh ; Tedrow, Usha ; Afzal, Mohammed R. ; Vergara, Pasquale ; Nagashima, Koichi ; Patel, Mehul ; Nakahara, Shiro ; Vakil, Kairav ; David Burkhardt, J. ; Tseng, Chi Hong ; Natale, Andrea ; Shivkumar, Kalyanam ; Callans, David J. ; Stevenson, William G. ; Della Bella, Paolo ; Marchlinski, Francis E. ; Sauer, William H. / Ventricular Tachycardia Ablation in Severe Heart Failure : An International Ventricular Tachycardia Ablation Center Collaboration Analysis. In: Circulation: Arrhythmia and Electrophysiology. 2017 ; Vol. 10, No. 1.
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abstract = "Background - Ventricular tachycardia (VT) radiofrequency ablation has been associated with reduced VT recurrence and mortality, although it is typically not considered among New York Heart Association class IV (NYHA IV) heart failure patients. We compared characteristics and VT radiofrequency ablation outcomes of those with and without NYHA IV in the International VT Ablation Center Collaboration. Methods and Results - NYHA II-IV patients undergoing VT radiofrequency ablation at 12 international centers were included. Clinical variables, VT recurrence, and mortality were analyzed by NYHA IV status using Kaplan-Meier analysis and Cox proportional hazard models. There were significant differences between NYHA IV (n=111) and NYHA II and III (n=1254) patients: NYHA IV had lower left ventricular ejection fraction; more had diabetes mellitus, kidney disease, cardiac resynchronization implantable cardioverter-defibrillator, and VT storm despite greater antiarrhythmic drug use (P<0.01). NYHA IV subjects required more hemodynamic support, were inducible for more and slower VTs, and were less likely to undergo final programmed stimulation. There was no significant difference in acute complications. In-hospital deaths, recurrent VT, and 1-year mortality were higher in the NYHA IV group, in the context of greater baseline comorbidities. Importantly, NYHA IV patients without recurrent VT had similar survival compared with NYHA II and III patients with recurrent VT (68{\%} versus 73{\%}). Early VT recurrence (≤30 days) was significantly associated with mortality, especially in NYHA IV patients. Conclusions - Despite greater baseline comorbidities, VT radiofrequency ablation can be safely performed among NYHA IV patients. Early VT recurrence is significantly associated with subsequent mortality regardless of NYHA status. Elimination of recurrent VT in NYHA IV patients may reduce mortality to a level comparable to NYHA II and III with arrhythmia recurrence.",
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T1 - Ventricular Tachycardia Ablation in Severe Heart Failure

T2 - An International Ventricular Tachycardia Ablation Center Collaboration Analysis

AU - Tzou, Wendy S.

AU - Tung, Roderick

AU - Frankel, David S.

AU - Vaseghi, Marmar

AU - Jared Bunch, T.

AU - Di Biase, Luigi

AU - Tholakanahalli, Venkatakrishna N.

AU - Lakkireddy, Dhanunjaya

AU - Dickfeld, Timm

AU - Saliaris, Anastasios

AU - Peter Weiss, J.

AU - Mathuria, Nilesh

AU - Tedrow, Usha

AU - Afzal, Mohammed R.

AU - Vergara, Pasquale

AU - Nagashima, Koichi

AU - Patel, Mehul

AU - Nakahara, Shiro

AU - Vakil, Kairav

AU - David Burkhardt, J.

AU - Tseng, Chi Hong

AU - Natale, Andrea

AU - Shivkumar, Kalyanam

AU - Callans, David J.

AU - Stevenson, William G.

AU - Della Bella, Paolo

AU - Marchlinski, Francis E.

AU - Sauer, William H.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background - Ventricular tachycardia (VT) radiofrequency ablation has been associated with reduced VT recurrence and mortality, although it is typically not considered among New York Heart Association class IV (NYHA IV) heart failure patients. We compared characteristics and VT radiofrequency ablation outcomes of those with and without NYHA IV in the International VT Ablation Center Collaboration. Methods and Results - NYHA II-IV patients undergoing VT radiofrequency ablation at 12 international centers were included. Clinical variables, VT recurrence, and mortality were analyzed by NYHA IV status using Kaplan-Meier analysis and Cox proportional hazard models. There were significant differences between NYHA IV (n=111) and NYHA II and III (n=1254) patients: NYHA IV had lower left ventricular ejection fraction; more had diabetes mellitus, kidney disease, cardiac resynchronization implantable cardioverter-defibrillator, and VT storm despite greater antiarrhythmic drug use (P<0.01). NYHA IV subjects required more hemodynamic support, were inducible for more and slower VTs, and were less likely to undergo final programmed stimulation. There was no significant difference in acute complications. In-hospital deaths, recurrent VT, and 1-year mortality were higher in the NYHA IV group, in the context of greater baseline comorbidities. Importantly, NYHA IV patients without recurrent VT had similar survival compared with NYHA II and III patients with recurrent VT (68% versus 73%). Early VT recurrence (≤30 days) was significantly associated with mortality, especially in NYHA IV patients. Conclusions - Despite greater baseline comorbidities, VT radiofrequency ablation can be safely performed among NYHA IV patients. Early VT recurrence is significantly associated with subsequent mortality regardless of NYHA status. Elimination of recurrent VT in NYHA IV patients may reduce mortality to a level comparable to NYHA II and III with arrhythmia recurrence.

AB - Background - Ventricular tachycardia (VT) radiofrequency ablation has been associated with reduced VT recurrence and mortality, although it is typically not considered among New York Heart Association class IV (NYHA IV) heart failure patients. We compared characteristics and VT radiofrequency ablation outcomes of those with and without NYHA IV in the International VT Ablation Center Collaboration. Methods and Results - NYHA II-IV patients undergoing VT radiofrequency ablation at 12 international centers were included. Clinical variables, VT recurrence, and mortality were analyzed by NYHA IV status using Kaplan-Meier analysis and Cox proportional hazard models. There were significant differences between NYHA IV (n=111) and NYHA II and III (n=1254) patients: NYHA IV had lower left ventricular ejection fraction; more had diabetes mellitus, kidney disease, cardiac resynchronization implantable cardioverter-defibrillator, and VT storm despite greater antiarrhythmic drug use (P<0.01). NYHA IV subjects required more hemodynamic support, were inducible for more and slower VTs, and were less likely to undergo final programmed stimulation. There was no significant difference in acute complications. In-hospital deaths, recurrent VT, and 1-year mortality were higher in the NYHA IV group, in the context of greater baseline comorbidities. Importantly, NYHA IV patients without recurrent VT had similar survival compared with NYHA II and III patients with recurrent VT (68% versus 73%). Early VT recurrence (≤30 days) was significantly associated with mortality, especially in NYHA IV patients. Conclusions - Despite greater baseline comorbidities, VT radiofrequency ablation can be safely performed among NYHA IV patients. Early VT recurrence is significantly associated with subsequent mortality regardless of NYHA status. Elimination of recurrent VT in NYHA IV patients may reduce mortality to a level comparable to NYHA II and III with arrhythmia recurrence.

KW - catheter ablation

KW - heart failure

KW - tachycardia, ventricular

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