Management of Ventricular Tachycardia in the Setting of a Dedicated Unit for the Treatment of Complex Ventricular Arrhythmias: Long-Term Outcome After Ablation
We investigated the impact of catheter ablation on ventricular tachycardia (VT) recurrence and survival in a large number of patients with structural heart disease treated in the setting of a dedicated multiskilled unit. Since January 2007, we have implemented a multidisciplinary model, aiming for a...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2013-04, Vol.127 (13), p.1359-1368 |
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| creator | DELLA BELLA, Paolo BARATTO, Francesca ALFIERI, Ottavio PAPPALARDO, Federico ZANGRILLO, Alberto MACCABELLI, Giuseppe TSIACHRIS, Dimitris TREVISI, Nicola VERGARA, Pasquale BISCEGLIA, Caterina PETRACCA, Francesco CARBUCICCHIO, Corrado BENUSSI, Stefano MAISANO, Francesco |
| description | We investigated the impact of catheter ablation on ventricular tachycardia (VT) recurrence and survival in a large number of patients with structural heart disease treated in the setting of a dedicated multiskilled unit.
Since January 2007, we have implemented a multidisciplinary model, aiming for a comprehensive management of VT patients. Programmed ventricular stimulation was used to assess acute outcome. Primary end points were VT recurrence and the occurrence of cardiac and sudden cardiac death. Overall, 528 patients were treated by ablation (634 procedures; 1-4 procedures per patient). Among 482 tested with programmed ventricular stimulation after the last procedure, a class A result (noninducibility of any VT) was obtained in 371 patients (77%), class B (inducibility of nondocumented VT) in 12.4%, and class C (inducibility of index VT) in 10.6%. After a median follow-up time of 26 months, VT recurred in 164 (34.1%) of 472 patients. VT recurrence was documented in 28.6% of patients with a class A result versus 39.6% of patients with class B and 66.7% with class C result (log-rank P |
| doi_str_mv | 10.1161/CIRCULATIONAHA.112.000872 |
| format | Article |
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Since January 2007, we have implemented a multidisciplinary model, aiming for a comprehensive management of VT patients. Programmed ventricular stimulation was used to assess acute outcome. Primary end points were VT recurrence and the occurrence of cardiac and sudden cardiac death. Overall, 528 patients were treated by ablation (634 procedures; 1-4 procedures per patient). Among 482 tested with programmed ventricular stimulation after the last procedure, a class A result (noninducibility of any VT) was obtained in 371 patients (77%), class B (inducibility of nondocumented VT) in 12.4%, and class C (inducibility of index VT) in 10.6%. After a median follow-up time of 26 months, VT recurred in 164 (34.1%) of 472 patients. VT recurrence was documented in 28.6% of patients with a class A result versus 39.6% of patients with class B and 66.7% with class C result (log-rank P<0.001). The incidence of cardiac mortality was lower in class A patients than in those with class B and class C (8.4% versus 18.5% versus 22%, respectively; log-rank P=0.002). On the basis of multivariate analysis, postprocedural inducibility of index VT was independently associated both with VT recurrence (hazard ratio, 4.030; P<0.001) and with cardiac mortality (hazard ratio, 2.099; P=0.04).
Within a dedicated VT unit, catheter ablation prevents long-term VT recurrences, which may favorably affect survival in a large number of patients who have VT.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.112.000872</identifier><identifier>PMID: 23439513</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Aged ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiac dysrhythmias ; Cardiology. Vascular system ; Catheter Ablation - methods ; Catheter Ablation - mortality ; Catheter Ablation - trends ; Cohort Studies ; Disease Management ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Female ; Follow-Up Studies ; Heart ; Heart failure, cardiogenic pulmonary edema, cardiac enlargement ; Hospital Units - trends ; Humans ; Male ; Medical sciences ; Middle Aged ; Patient Admission - trends ; Prospective Studies ; Tachycardia, Ventricular - diagnosis ; Tachycardia, Ventricular - mortality ; Tachycardia, Ventricular - therapy ; Time Factors ; Treatment Outcome</subject><ispartof>Circulation (New York, N.Y.), 2013-04, Vol.127 (13), p.1359-1368</ispartof><rights>2014 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c291t-4595d9610f075fb98e9d3f3b267b946edc9650db4910d5e3458034fc370c6a823</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3687,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27199590$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23439513$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>DELLA BELLA, Paolo</creatorcontrib><creatorcontrib>BARATTO, Francesca</creatorcontrib><creatorcontrib>ALFIERI, Ottavio</creatorcontrib><creatorcontrib>PAPPALARDO, Federico</creatorcontrib><creatorcontrib>ZANGRILLO, Alberto</creatorcontrib><creatorcontrib>MACCABELLI, Giuseppe</creatorcontrib><creatorcontrib>TSIACHRIS, Dimitris</creatorcontrib><creatorcontrib>TREVISI, Nicola</creatorcontrib><creatorcontrib>VERGARA, Pasquale</creatorcontrib><creatorcontrib>BISCEGLIA, Caterina</creatorcontrib><creatorcontrib>PETRACCA, Francesco</creatorcontrib><creatorcontrib>CARBUCICCHIO, Corrado</creatorcontrib><creatorcontrib>BENUSSI, Stefano</creatorcontrib><creatorcontrib>MAISANO, Francesco</creatorcontrib><title>Management of Ventricular Tachycardia in the Setting of a Dedicated Unit for the Treatment of Complex Ventricular Arrhythmias: Long-Term Outcome After Ablation</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>We investigated the impact of catheter ablation on ventricular tachycardia (VT) recurrence and survival in a large number of patients with structural heart disease treated in the setting of a dedicated multiskilled unit.
Since January 2007, we have implemented a multidisciplinary model, aiming for a comprehensive management of VT patients. Programmed ventricular stimulation was used to assess acute outcome. Primary end points were VT recurrence and the occurrence of cardiac and sudden cardiac death. Overall, 528 patients were treated by ablation (634 procedures; 1-4 procedures per patient). Among 482 tested with programmed ventricular stimulation after the last procedure, a class A result (noninducibility of any VT) was obtained in 371 patients (77%), class B (inducibility of nondocumented VT) in 12.4%, and class C (inducibility of index VT) in 10.6%. After a median follow-up time of 26 months, VT recurred in 164 (34.1%) of 472 patients. VT recurrence was documented in 28.6% of patients with a class A result versus 39.6% of patients with class B and 66.7% with class C result (log-rank P<0.001). The incidence of cardiac mortality was lower in class A patients than in those with class B and class C (8.4% versus 18.5% versus 22%, respectively; log-rank P=0.002). On the basis of multivariate analysis, postprocedural inducibility of index VT was independently associated both with VT recurrence (hazard ratio, 4.030; P<0.001) and with cardiac mortality (hazard ratio, 2.099; P=0.04).
Within a dedicated VT unit, catheter ablation prevents long-term VT recurrences, which may favorably affect survival in a large number of patients who have VT.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiac dysrhythmias</subject><subject>Cardiology. Vascular system</subject><subject>Catheter Ablation - methods</subject><subject>Catheter Ablation - mortality</subject><subject>Catheter Ablation - trends</subject><subject>Cohort Studies</subject><subject>Disease Management</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart</subject><subject>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</subject><subject>Hospital Units - trends</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Patient Admission - trends</subject><subject>Prospective Studies</subject><subject>Tachycardia, Ventricular - diagnosis</subject><subject>Tachycardia, Ventricular - mortality</subject><subject>Tachycardia, Ventricular - therapy</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkVuP0zAQhS0EYsvCX0DmAYmXLL7EScxbFC5bqVAJUl4jxx63RrkU25Hor-Gv4qVd0D6N5ug7ZzQ6CL2i5IbSgr5t1l-b3aZu19sv9W2dNHZDCKlK9gitqGB5lgsuH6NVEmVWcsau0LMQfqS14KV4iq4Yz7kUlK_Q789qUnsYYYp4tvh7mt7pZVAet0ofTlp54xR2E44HwN8gRjft70iF34NxWkUweDe5iO3s_zKtBxXv85p5PA7w60Fu7f3hFA-jU-Ed3szTPmvBj3i7RD2PgGsbIUH9oKKbp-foiVVDgBeXeY12Hz-0zW222X5aN_Um00zSmB6WwsiCEktKYXtZgTTc8p4VZS_zAoyWhSCmzyUlRgDPRUV4bjUviS5Uxfg1enPOPfr55wIhdqMLGoZBTTAvoaOccVZWBeEJlWdU-zkED7Y7ejcqf-oo6e766R72kzTWnftJ3peXM0s_gvnnvC8kAa8vgApaDdarSbvwnyuplEIS_gcEs5u6</recordid><startdate>20130402</startdate><enddate>20130402</enddate><creator>DELLA BELLA, Paolo</creator><creator>BARATTO, Francesca</creator><creator>ALFIERI, Ottavio</creator><creator>PAPPALARDO, Federico</creator><creator>ZANGRILLO, Alberto</creator><creator>MACCABELLI, Giuseppe</creator><creator>TSIACHRIS, Dimitris</creator><creator>TREVISI, Nicola</creator><creator>VERGARA, Pasquale</creator><creator>BISCEGLIA, Caterina</creator><creator>PETRACCA, Francesco</creator><creator>CARBUCICCHIO, Corrado</creator><creator>BENUSSI, Stefano</creator><creator>MAISANO, Francesco</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130402</creationdate><title>Management of Ventricular Tachycardia in the Setting of a Dedicated Unit for the Treatment of Complex Ventricular Arrhythmias: Long-Term Outcome After Ablation</title><author>DELLA BELLA, Paolo ; BARATTO, Francesca ; ALFIERI, Ottavio ; PAPPALARDO, Federico ; ZANGRILLO, Alberto ; MACCABELLI, Giuseppe ; TSIACHRIS, Dimitris ; TREVISI, Nicola ; VERGARA, Pasquale ; BISCEGLIA, Caterina ; PETRACCA, Francesco ; CARBUCICCHIO, Corrado ; BENUSSI, Stefano ; MAISANO, Francesco</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c291t-4595d9610f075fb98e9d3f3b267b946edc9650db4910d5e3458034fc370c6a823</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiac dysrhythmias</topic><topic>Cardiology. Vascular system</topic><topic>Catheter Ablation - methods</topic><topic>Catheter Ablation - mortality</topic><topic>Catheter Ablation - trends</topic><topic>Cohort Studies</topic><topic>Disease Management</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. 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Since January 2007, we have implemented a multidisciplinary model, aiming for a comprehensive management of VT patients. Programmed ventricular stimulation was used to assess acute outcome. Primary end points were VT recurrence and the occurrence of cardiac and sudden cardiac death. Overall, 528 patients were treated by ablation (634 procedures; 1-4 procedures per patient). Among 482 tested with programmed ventricular stimulation after the last procedure, a class A result (noninducibility of any VT) was obtained in 371 patients (77%), class B (inducibility of nondocumented VT) in 12.4%, and class C (inducibility of index VT) in 10.6%. After a median follow-up time of 26 months, VT recurred in 164 (34.1%) of 472 patients. VT recurrence was documented in 28.6% of patients with a class A result versus 39.6% of patients with class B and 66.7% with class C result (log-rank P<0.001). The incidence of cardiac mortality was lower in class A patients than in those with class B and class C (8.4% versus 18.5% versus 22%, respectively; log-rank P=0.002). On the basis of multivariate analysis, postprocedural inducibility of index VT was independently associated both with VT recurrence (hazard ratio, 4.030; P<0.001) and with cardiac mortality (hazard ratio, 2.099; P=0.04).
Within a dedicated VT unit, catheter ablation prevents long-term VT recurrences, which may favorably affect survival in a large number of patients who have VT.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>23439513</pmid><doi>10.1161/CIRCULATIONAHA.112.000872</doi><tpages>10</tpages></addata></record> |
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| source | MEDLINE; American Heart Association Journals; Journals@Ovid Complete; EZB-FREE-00999 freely available EZB journals |
| subjects | Aged Biological and medical sciences Blood and lymphatic vessels Cardiac dysrhythmias Cardiology. Vascular system Catheter Ablation - methods Catheter Ablation - mortality Catheter Ablation - trends Cohort Studies Disease Management Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Female Follow-Up Studies Heart Heart failure, cardiogenic pulmonary edema, cardiac enlargement Hospital Units - trends Humans Male Medical sciences Middle Aged Patient Admission - trends Prospective Studies Tachycardia, Ventricular - diagnosis Tachycardia, Ventricular - mortality Tachycardia, Ventricular - therapy Time Factors Treatment Outcome |
| title | Management of Ventricular Tachycardia in the Setting of a Dedicated Unit for the Treatment of Complex Ventricular Arrhythmias: Long-Term Outcome After Ablation |
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