Impact of repeat ablation of ventricular tachycardia in patients with structural heart disease
Abstract Aims Recurrences of ventricular tachycardia (VT) after initial catheter ablation is a significant clinical problem. In this study, we report the efficacy and risks of repeat VT ablation in patients with structural heart disease (SHD) in a tertiary single centre over a 7-year period. Methods...
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| Veröffentlicht in: | Europace (London, England) England), 2023-12, Vol.26 (1) |
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| container_title | Europace (London, England) |
| container_volume | 26 |
| creator | Garcia Garcia, Joaquin Arya, Arash Dinov, Borislav Bollmann, Andreas ter Bekke, Rachel M A Vernooy, Kevin Dagres, Nikolaos Hindricks, Gerhard Darma, Angeliki |
| description | Abstract
Aims
Recurrences of ventricular tachycardia (VT) after initial catheter ablation is a significant clinical problem. In this study, we report the efficacy and risks of repeat VT ablation in patients with structural heart disease (SHD) in a tertiary single centre over a 7-year period.
Methods and results
Two hundred ten consecutive patients referred for repeat VT ablation after previous ablation in our institution were included in the analysis (53% ischaemic cardiomyopathy, 91% males, median age 65 years, mean left ventricular ejection fraction 35%). After performing repeat ablation, the clinical VTs were acutely eliminated in 82% of the patients, but 46% of the cohort presented with VT recurrence during the 25-month follow-up. Repeat ablation led to a 73% reduction of shock burden in the first year and 61% reduction until the end of follow-up. Similarly, VT burden was reduced 55% in the first year and 36% until the end of the study. Fifty-two patients (25%) reached the combined endpoint of ventricular assist device implantation, heart transplantation, or death. Advanced New York Heart Association functional class, anteroseptal substrate, and periprocedural complication after repeat ablation were associated with worse prognosis independently of the type of cardiomyopathy.
Conclusion
While complete freedom from VT after repeat ablation in SHD was difficult to achieve, ablation led to a significant reduction in VT and shock burden. Besides advanced heart failure characteristics, anteroseptal substrate and periprocedural complications predicted a worse outcome.
Graphical Abstract
Graphical Abstract |
| doi_str_mv | 10.1093/europace/euad367 |
| format | Article |
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Aims
Recurrences of ventricular tachycardia (VT) after initial catheter ablation is a significant clinical problem. In this study, we report the efficacy and risks of repeat VT ablation in patients with structural heart disease (SHD) in a tertiary single centre over a 7-year period.
Methods and results
Two hundred ten consecutive patients referred for repeat VT ablation after previous ablation in our institution were included in the analysis (53% ischaemic cardiomyopathy, 91% males, median age 65 years, mean left ventricular ejection fraction 35%). After performing repeat ablation, the clinical VTs were acutely eliminated in 82% of the patients, but 46% of the cohort presented with VT recurrence during the 25-month follow-up. Repeat ablation led to a 73% reduction of shock burden in the first year and 61% reduction until the end of follow-up. Similarly, VT burden was reduced 55% in the first year and 36% until the end of the study. Fifty-two patients (25%) reached the combined endpoint of ventricular assist device implantation, heart transplantation, or death. Advanced New York Heart Association functional class, anteroseptal substrate, and periprocedural complication after repeat ablation were associated with worse prognosis independently of the type of cardiomyopathy.
Conclusion
While complete freedom from VT after repeat ablation in SHD was difficult to achieve, ablation led to a significant reduction in VT and shock burden. Besides advanced heart failure characteristics, anteroseptal substrate and periprocedural complications predicted a worse outcome.
Graphical Abstract
Graphical Abstract</description><identifier>ISSN: 1099-5129</identifier><identifier>EISSN: 1532-2092</identifier><identifier>DOI: 10.1093/europace/euad367</identifier><identifier>PMID: 38127308</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Ablation ; Cardiac arrhythmia ; Cardiomyopathy ; Cardiovascular disease ; Congestive heart failure ; Heart ; Heart diseases ; Heart transplantation ; Ischemia ; Tachycardia ; Ventricle</subject><ispartof>Europace (London, England), 2023-12, Vol.26 (1)</ispartof><rights>The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. 2023</rights><rights>The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c405t-eb0425991787bcbd782f90272cbebb9dc65fa9edffaa47d5db16fbf800f60a573</citedby><cites>FETCH-LOGICAL-c405t-eb0425991787bcbd782f90272cbebb9dc65fa9edffaa47d5db16fbf800f60a573</cites><orcidid>0000-0002-5441-3906 ; 0000-0002-8818-5964 ; 0000-0003-0323-4956 ; 0000-0002-0132-0773 ; 0000-0003-4278-0132 ; 0000-0003-4756-2775 ; 0009-0002-2915-4380 ; 0000-0003-1104-8491</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,1599,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38127308$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Garcia Garcia, Joaquin</creatorcontrib><creatorcontrib>Arya, Arash</creatorcontrib><creatorcontrib>Dinov, Borislav</creatorcontrib><creatorcontrib>Bollmann, Andreas</creatorcontrib><creatorcontrib>ter Bekke, Rachel M A</creatorcontrib><creatorcontrib>Vernooy, Kevin</creatorcontrib><creatorcontrib>Dagres, Nikolaos</creatorcontrib><creatorcontrib>Hindricks, Gerhard</creatorcontrib><creatorcontrib>Darma, Angeliki</creatorcontrib><title>Impact of repeat ablation of ventricular tachycardia in patients with structural heart disease</title><title>Europace (London, England)</title><addtitle>Europace</addtitle><description>Abstract
Aims
Recurrences of ventricular tachycardia (VT) after initial catheter ablation is a significant clinical problem. In this study, we report the efficacy and risks of repeat VT ablation in patients with structural heart disease (SHD) in a tertiary single centre over a 7-year period.
Methods and results
Two hundred ten consecutive patients referred for repeat VT ablation after previous ablation in our institution were included in the analysis (53% ischaemic cardiomyopathy, 91% males, median age 65 years, mean left ventricular ejection fraction 35%). After performing repeat ablation, the clinical VTs were acutely eliminated in 82% of the patients, but 46% of the cohort presented with VT recurrence during the 25-month follow-up. Repeat ablation led to a 73% reduction of shock burden in the first year and 61% reduction until the end of follow-up. Similarly, VT burden was reduced 55% in the first year and 36% until the end of the study. Fifty-two patients (25%) reached the combined endpoint of ventricular assist device implantation, heart transplantation, or death. Advanced New York Heart Association functional class, anteroseptal substrate, and periprocedural complication after repeat ablation were associated with worse prognosis independently of the type of cardiomyopathy.
Conclusion
While complete freedom from VT after repeat ablation in SHD was difficult to achieve, ablation led to a significant reduction in VT and shock burden. Besides advanced heart failure characteristics, anteroseptal substrate and periprocedural complications predicted a worse outcome.
Graphical Abstract
Graphical Abstract</description><subject>Ablation</subject><subject>Cardiac arrhythmia</subject><subject>Cardiomyopathy</subject><subject>Cardiovascular disease</subject><subject>Congestive heart failure</subject><subject>Heart</subject><subject>Heart diseases</subject><subject>Heart transplantation</subject><subject>Ischemia</subject><subject>Tachycardia</subject><subject>Ventricle</subject><issn>1099-5129</issn><issn>1532-2092</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><recordid>eNqFkEtr3TAQhUVoaR7tPqsi6CYQ3Iwky7KWJTQPCGTTbGtGL66Dr-3qkZJ_X4V7k0U3Wc1h5juH4RByyuA7Ay0ufInLitZXgU506oAcMSl4w0HzD1WD1o1kXB-S45QeAUBxLT-RQ9EzrgT0R-T37bYGZLoEGv3qMVM0E-ZxmV9WT37OcbRlwkgz2s2zxehGpONM1wrVa6J_x7yhKcdic4k40Y3HmKkbk8fkP5OPAafkv-znCXm4-vnr8qa5u7--vfxx19gWZG68gZZLrZnqlbHGqZ4HDVxxa7wx2tlOBtTehYDYKiedYV0woQcIHaBU4oSc7XLXuPwpPuVhOybrpwlnv5Q0cA2tVKxloqLf_kMflxLn-t0gGG9boXvoKgU7ysYlpejDsMZxi_F5YDC8dD-8dj_su6-Wr_vgYrbevRley67A-Q5Yyvp-3D_fTZPI</recordid><startdate>20231228</startdate><enddate>20231228</enddate><creator>Garcia Garcia, Joaquin</creator><creator>Arya, Arash</creator><creator>Dinov, Borislav</creator><creator>Bollmann, Andreas</creator><creator>ter Bekke, Rachel M A</creator><creator>Vernooy, Kevin</creator><creator>Dagres, Nikolaos</creator><creator>Hindricks, Gerhard</creator><creator>Darma, Angeliki</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>TOX</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5441-3906</orcidid><orcidid>https://orcid.org/0000-0002-8818-5964</orcidid><orcidid>https://orcid.org/0000-0003-0323-4956</orcidid><orcidid>https://orcid.org/0000-0002-0132-0773</orcidid><orcidid>https://orcid.org/0000-0003-4278-0132</orcidid><orcidid>https://orcid.org/0000-0003-4756-2775</orcidid><orcidid>https://orcid.org/0009-0002-2915-4380</orcidid><orcidid>https://orcid.org/0000-0003-1104-8491</orcidid></search><sort><creationdate>20231228</creationdate><title>Impact of repeat ablation of ventricular tachycardia in patients with structural heart disease</title><author>Garcia Garcia, Joaquin ; Arya, Arash ; Dinov, Borislav ; Bollmann, Andreas ; ter Bekke, Rachel M A ; Vernooy, Kevin ; Dagres, Nikolaos ; Hindricks, Gerhard ; Darma, Angeliki</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c405t-eb0425991787bcbd782f90272cbebb9dc65fa9edffaa47d5db16fbf800f60a573</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Ablation</topic><topic>Cardiac arrhythmia</topic><topic>Cardiomyopathy</topic><topic>Cardiovascular disease</topic><topic>Congestive heart failure</topic><topic>Heart</topic><topic>Heart diseases</topic><topic>Heart transplantation</topic><topic>Ischemia</topic><topic>Tachycardia</topic><topic>Ventricle</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Garcia Garcia, Joaquin</creatorcontrib><creatorcontrib>Arya, Arash</creatorcontrib><creatorcontrib>Dinov, Borislav</creatorcontrib><creatorcontrib>Bollmann, Andreas</creatorcontrib><creatorcontrib>ter Bekke, Rachel M A</creatorcontrib><creatorcontrib>Vernooy, Kevin</creatorcontrib><creatorcontrib>Dagres, Nikolaos</creatorcontrib><creatorcontrib>Hindricks, Gerhard</creatorcontrib><creatorcontrib>Darma, Angeliki</creatorcontrib><collection>Oxford Journals Open Access Collection</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Europace (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Garcia Garcia, Joaquin</au><au>Arya, Arash</au><au>Dinov, Borislav</au><au>Bollmann, Andreas</au><au>ter Bekke, Rachel M A</au><au>Vernooy, Kevin</au><au>Dagres, Nikolaos</au><au>Hindricks, Gerhard</au><au>Darma, Angeliki</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of repeat ablation of ventricular tachycardia in patients with structural heart disease</atitle><jtitle>Europace (London, England)</jtitle><addtitle>Europace</addtitle><date>2023-12-28</date><risdate>2023</risdate><volume>26</volume><issue>1</issue><issn>1099-5129</issn><eissn>1532-2092</eissn><abstract>Abstract
Aims
Recurrences of ventricular tachycardia (VT) after initial catheter ablation is a significant clinical problem. In this study, we report the efficacy and risks of repeat VT ablation in patients with structural heart disease (SHD) in a tertiary single centre over a 7-year period.
Methods and results
Two hundred ten consecutive patients referred for repeat VT ablation after previous ablation in our institution were included in the analysis (53% ischaemic cardiomyopathy, 91% males, median age 65 years, mean left ventricular ejection fraction 35%). After performing repeat ablation, the clinical VTs were acutely eliminated in 82% of the patients, but 46% of the cohort presented with VT recurrence during the 25-month follow-up. Repeat ablation led to a 73% reduction of shock burden in the first year and 61% reduction until the end of follow-up. Similarly, VT burden was reduced 55% in the first year and 36% until the end of the study. Fifty-two patients (25%) reached the combined endpoint of ventricular assist device implantation, heart transplantation, or death. Advanced New York Heart Association functional class, anteroseptal substrate, and periprocedural complication after repeat ablation were associated with worse prognosis independently of the type of cardiomyopathy.
Conclusion
While complete freedom from VT after repeat ablation in SHD was difficult to achieve, ablation led to a significant reduction in VT and shock burden. Besides advanced heart failure characteristics, anteroseptal substrate and periprocedural complications predicted a worse outcome.
Graphical Abstract
Graphical Abstract</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>38127308</pmid><doi>10.1093/europace/euad367</doi><orcidid>https://orcid.org/0000-0002-5441-3906</orcidid><orcidid>https://orcid.org/0000-0002-8818-5964</orcidid><orcidid>https://orcid.org/0000-0003-0323-4956</orcidid><orcidid>https://orcid.org/0000-0002-0132-0773</orcidid><orcidid>https://orcid.org/0000-0003-4278-0132</orcidid><orcidid>https://orcid.org/0000-0003-4756-2775</orcidid><orcidid>https://orcid.org/0009-0002-2915-4380</orcidid><orcidid>https://orcid.org/0000-0003-1104-8491</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1099-5129 |
| ispartof | Europace (London, England), 2023-12, Vol.26 (1) |
| issn | 1099-5129 1532-2092 |
| language | eng |
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| source | Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Oxford Journals Open Access Collection; PubMed Central; Alma/SFX Local Collection |
| subjects | Ablation Cardiac arrhythmia Cardiomyopathy Cardiovascular disease Congestive heart failure Heart Heart diseases Heart transplantation Ischemia Tachycardia Ventricle |
| title | Impact of repeat ablation of ventricular tachycardia in patients with structural heart disease |
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