Ventricular tachycardia ablation in structural heart disease: Impact of ablation strategy and non-inducibility as an end-point on long term outcome
To investigate the long term outcomes after catheter ablation (CA) of ventricular tachycardia (VT) in the context of structural heart disease in a multicenter cohort. The impact of different ablation strategies (substrate ablation versus activation guided versus combined) and non-inducibility as an...
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| Veröffentlicht in: | International journal of cardiology 2019-02, Vol.277, p.110-117 |
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| container_title | International journal of cardiology |
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| creator | Breitenstein, Alexander Sawhney, Vinit Providencia, Rui Honarbakhsh, Shohreh Ullah, Waqas Dhinoja, Mehul B. Schilling, Richard J. Babu, Girish G. Chow, Anthony Lambiase, Pier Rajappan, Kim Kalla, Manish Cassar, Mark Hall, Mark Temple, Ian P. Bartoletti, Stefano Panikker, Sandeep Kontogeorgis, Andrew Wong, Tom Hunter, Ross J. |
| description | To investigate the long term outcomes after catheter ablation (CA) of ventricular tachycardia (VT) in the context of structural heart disease in a multicenter cohort. The impact of different ablation strategies (substrate ablation versus activation guided versus combined) and non-inducibility as an end-point was evaluated.
Data was pooled from prospective registries at 5 centres over a 5 year period. Success was defined as survival free from recurrent ventricular arrhythmias (VA). Multivariate analysis of factors predicting survival free from VA was analysed by Cox regression.
Five hundred sixty-six patients underwent CA for VT. Patients were 64 ± 15 years. Left ventricular ejection fraction was 35 ± 15% and 66% had ischaemic heart disease. At 2.3 (IQR 1.0–4.2) years, success was achieved in 44% after a single procedure, rising to 60% after repeat procedures. Mortality at final follow up was 22%. Multivariate analysis showed that higher left ventricular ejection fraction, younger age, ischaemic heart disease, and non-inducibility of VA predicted long term survival free from VA (all p |
| doi_str_mv | 10.1016/j.ijcard.2018.08.099 |
| format | Article |
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Data was pooled from prospective registries at 5 centres over a 5 year period. Success was defined as survival free from recurrent ventricular arrhythmias (VA). Multivariate analysis of factors predicting survival free from VA was analysed by Cox regression.
Five hundred sixty-six patients underwent CA for VT. Patients were 64 ± 15 years. Left ventricular ejection fraction was 35 ± 15% and 66% had ischaemic heart disease. At 2.3 (IQR 1.0–4.2) years, success was achieved in 44% after a single procedure, rising to 60% after repeat procedures. Mortality at final follow up was 22%. Multivariate analysis showed that higher left ventricular ejection fraction, younger age, ischaemic heart disease, and non-inducibility of VA predicted long term survival free from VA (all p < 0.05). There was no impact of the approach to ablation.
CA eliminates VT in a large proportion of patients long term. Ablation strategy did not impact outcome and hence substrate ablation is a reasonable initial strategy. Non-inducibility of VA predicted survival free from VA and may be worth pursuing as a procedural end-point.
•Largest registries of structural VT ablations•Success was achieved in 45% after a single and 60% after repeat procedures.•The study demonstrates non-inducibility as a strong predictor of favourable outcome.</description><identifier>ISSN: 0167-5273</identifier><identifier>EISSN: 1874-1754</identifier><identifier>DOI: 10.1016/j.ijcard.2018.08.099</identifier><identifier>PMID: 30196998</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Catheter ablation ; Outcome ; Ventricular tachycardia</subject><ispartof>International journal of cardiology, 2019-02, Vol.277, p.110-117</ispartof><rights>2018 Elsevier B.V.</rights><rights>Copyright © 2018 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c408t-c1621161ba2d490eeada7fffdf6344c0595f8ceb408c7099d6d68e8cb74338ee3</citedby><cites>FETCH-LOGICAL-c408t-c1621161ba2d490eeada7fffdf6344c0595f8ceb408c7099d6d68e8cb74338ee3</cites><orcidid>0000-0001-9141-9883 ; 0000-0002-6484-4961</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0167527318335307$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30196998$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Breitenstein, Alexander</creatorcontrib><creatorcontrib>Sawhney, Vinit</creatorcontrib><creatorcontrib>Providencia, Rui</creatorcontrib><creatorcontrib>Honarbakhsh, Shohreh</creatorcontrib><creatorcontrib>Ullah, Waqas</creatorcontrib><creatorcontrib>Dhinoja, Mehul B.</creatorcontrib><creatorcontrib>Schilling, Richard J.</creatorcontrib><creatorcontrib>Babu, Girish G.</creatorcontrib><creatorcontrib>Chow, Anthony</creatorcontrib><creatorcontrib>Lambiase, Pier</creatorcontrib><creatorcontrib>Rajappan, Kim</creatorcontrib><creatorcontrib>Kalla, Manish</creatorcontrib><creatorcontrib>Cassar, Mark</creatorcontrib><creatorcontrib>Hall, Mark</creatorcontrib><creatorcontrib>Temple, Ian P.</creatorcontrib><creatorcontrib>Bartoletti, Stefano</creatorcontrib><creatorcontrib>Panikker, Sandeep</creatorcontrib><creatorcontrib>Kontogeorgis, Andrew</creatorcontrib><creatorcontrib>Wong, Tom</creatorcontrib><creatorcontrib>Hunter, Ross J.</creatorcontrib><title>Ventricular tachycardia ablation in structural heart disease: Impact of ablation strategy and non-inducibility as an end-point on long term outcome</title><title>International journal of cardiology</title><addtitle>Int J Cardiol</addtitle><description>To investigate the long term outcomes after catheter ablation (CA) of ventricular tachycardia (VT) in the context of structural heart disease in a multicenter cohort. The impact of different ablation strategies (substrate ablation versus activation guided versus combined) and non-inducibility as an end-point was evaluated.
Data was pooled from prospective registries at 5 centres over a 5 year period. Success was defined as survival free from recurrent ventricular arrhythmias (VA). Multivariate analysis of factors predicting survival free from VA was analysed by Cox regression.
Five hundred sixty-six patients underwent CA for VT. Patients were 64 ± 15 years. Left ventricular ejection fraction was 35 ± 15% and 66% had ischaemic heart disease. At 2.3 (IQR 1.0–4.2) years, success was achieved in 44% after a single procedure, rising to 60% after repeat procedures. Mortality at final follow up was 22%. Multivariate analysis showed that higher left ventricular ejection fraction, younger age, ischaemic heart disease, and non-inducibility of VA predicted long term survival free from VA (all p < 0.05). There was no impact of the approach to ablation.
CA eliminates VT in a large proportion of patients long term. Ablation strategy did not impact outcome and hence substrate ablation is a reasonable initial strategy. Non-inducibility of VA predicted survival free from VA and may be worth pursuing as a procedural end-point.
•Largest registries of structural VT ablations•Success was achieved in 45% after a single and 60% after repeat procedures.•The study demonstrates non-inducibility as a strong predictor of favourable outcome.</description><subject>Catheter ablation</subject><subject>Outcome</subject><subject>Ventricular tachycardia</subject><issn>0167-5273</issn><issn>1874-1754</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp9kd9qFTEQxoMo7bH2DURy6c0ek_2beCFIaW2h4I16G2Yns20Ou8kxyQrnOXxhczhV7woDCcPvm2G-j7G3UmylkP2H3dbtEKLd1kKqrSil9Qu2kWpoKzl07Uu2KdhQdfXQnLPXKe2EEK3W6oydN0Lqvnw37PcP8jk6XGeIPAM-Ho4zHXAYZ8gueO48TzmumNcIM38kiJlblwgSfeR3yx4w8zD95wsMmR4OHLzlPvjKebuiG93scmmm0ufkbbUPzhel53PwDzxTXHhYM4aF3rBXE8yJLp_eC_b95vrb1W11__XL3dXn-wpboXKFsq-l7OUItW21IAILwzRNduqbtkXR6W5SSGOBcSjm2N72ihSOQ9s0iqi5YO9Pc_cx_FwpZbO4hDTP4CmsydTFZy1VM3QFbU8oxpBSpMnso1sgHowU5hiH2ZlTHOYYhxGltC6yd08b1nEh-0_01_8CfDoBVO785SiahI48knWRMBsb3PMb_gBYE6Fk</recordid><startdate>20190215</startdate><enddate>20190215</enddate><creator>Breitenstein, Alexander</creator><creator>Sawhney, Vinit</creator><creator>Providencia, Rui</creator><creator>Honarbakhsh, Shohreh</creator><creator>Ullah, Waqas</creator><creator>Dhinoja, Mehul B.</creator><creator>Schilling, Richard J.</creator><creator>Babu, Girish G.</creator><creator>Chow, Anthony</creator><creator>Lambiase, Pier</creator><creator>Rajappan, Kim</creator><creator>Kalla, Manish</creator><creator>Cassar, Mark</creator><creator>Hall, Mark</creator><creator>Temple, Ian P.</creator><creator>Bartoletti, Stefano</creator><creator>Panikker, Sandeep</creator><creator>Kontogeorgis, Andrew</creator><creator>Wong, Tom</creator><creator>Hunter, Ross J.</creator><general>Elsevier B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9141-9883</orcidid><orcidid>https://orcid.org/0000-0002-6484-4961</orcidid></search><sort><creationdate>20190215</creationdate><title>Ventricular tachycardia ablation in structural heart disease: Impact of ablation strategy and non-inducibility as an end-point on long term outcome</title><author>Breitenstein, Alexander ; Sawhney, Vinit ; Providencia, Rui ; Honarbakhsh, Shohreh ; Ullah, Waqas ; Dhinoja, Mehul B. ; Schilling, Richard J. ; Babu, Girish G. ; Chow, Anthony ; Lambiase, Pier ; Rajappan, Kim ; Kalla, Manish ; Cassar, Mark ; Hall, Mark ; Temple, Ian P. ; Bartoletti, Stefano ; Panikker, Sandeep ; Kontogeorgis, Andrew ; Wong, Tom ; Hunter, Ross J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c408t-c1621161ba2d490eeada7fffdf6344c0595f8ceb408c7099d6d68e8cb74338ee3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Catheter ablation</topic><topic>Outcome</topic><topic>Ventricular tachycardia</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Breitenstein, Alexander</creatorcontrib><creatorcontrib>Sawhney, Vinit</creatorcontrib><creatorcontrib>Providencia, Rui</creatorcontrib><creatorcontrib>Honarbakhsh, Shohreh</creatorcontrib><creatorcontrib>Ullah, Waqas</creatorcontrib><creatorcontrib>Dhinoja, Mehul B.</creatorcontrib><creatorcontrib>Schilling, Richard J.</creatorcontrib><creatorcontrib>Babu, Girish G.</creatorcontrib><creatorcontrib>Chow, Anthony</creatorcontrib><creatorcontrib>Lambiase, Pier</creatorcontrib><creatorcontrib>Rajappan, Kim</creatorcontrib><creatorcontrib>Kalla, Manish</creatorcontrib><creatorcontrib>Cassar, Mark</creatorcontrib><creatorcontrib>Hall, Mark</creatorcontrib><creatorcontrib>Temple, Ian P.</creatorcontrib><creatorcontrib>Bartoletti, Stefano</creatorcontrib><creatorcontrib>Panikker, Sandeep</creatorcontrib><creatorcontrib>Kontogeorgis, Andrew</creatorcontrib><creatorcontrib>Wong, Tom</creatorcontrib><creatorcontrib>Hunter, Ross J.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Breitenstein, Alexander</au><au>Sawhney, Vinit</au><au>Providencia, Rui</au><au>Honarbakhsh, Shohreh</au><au>Ullah, Waqas</au><au>Dhinoja, Mehul B.</au><au>Schilling, Richard J.</au><au>Babu, Girish G.</au><au>Chow, Anthony</au><au>Lambiase, Pier</au><au>Rajappan, Kim</au><au>Kalla, Manish</au><au>Cassar, Mark</au><au>Hall, Mark</au><au>Temple, Ian P.</au><au>Bartoletti, Stefano</au><au>Panikker, Sandeep</au><au>Kontogeorgis, Andrew</au><au>Wong, Tom</au><au>Hunter, Ross J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ventricular tachycardia ablation in structural heart disease: Impact of ablation strategy and non-inducibility as an end-point on long term outcome</atitle><jtitle>International journal of cardiology</jtitle><addtitle>Int J Cardiol</addtitle><date>2019-02-15</date><risdate>2019</risdate><volume>277</volume><spage>110</spage><epage>117</epage><pages>110-117</pages><issn>0167-5273</issn><eissn>1874-1754</eissn><abstract>To investigate the long term outcomes after catheter ablation (CA) of ventricular tachycardia (VT) in the context of structural heart disease in a multicenter cohort. The impact of different ablation strategies (substrate ablation versus activation guided versus combined) and non-inducibility as an end-point was evaluated.
Data was pooled from prospective registries at 5 centres over a 5 year period. Success was defined as survival free from recurrent ventricular arrhythmias (VA). Multivariate analysis of factors predicting survival free from VA was analysed by Cox regression.
Five hundred sixty-six patients underwent CA for VT. Patients were 64 ± 15 years. Left ventricular ejection fraction was 35 ± 15% and 66% had ischaemic heart disease. At 2.3 (IQR 1.0–4.2) years, success was achieved in 44% after a single procedure, rising to 60% after repeat procedures. Mortality at final follow up was 22%. Multivariate analysis showed that higher left ventricular ejection fraction, younger age, ischaemic heart disease, and non-inducibility of VA predicted long term survival free from VA (all p < 0.05). There was no impact of the approach to ablation.
CA eliminates VT in a large proportion of patients long term. Ablation strategy did not impact outcome and hence substrate ablation is a reasonable initial strategy. Non-inducibility of VA predicted survival free from VA and may be worth pursuing as a procedural end-point.
•Largest registries of structural VT ablations•Success was achieved in 45% after a single and 60% after repeat procedures.•The study demonstrates non-inducibility as a strong predictor of favourable outcome.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>30196998</pmid><doi>10.1016/j.ijcard.2018.08.099</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-9141-9883</orcidid><orcidid>https://orcid.org/0000-0002-6484-4961</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Catheter ablation Outcome Ventricular tachycardia |
| title | Ventricular tachycardia ablation in structural heart disease: Impact of ablation strategy and non-inducibility as an end-point on long term outcome |
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