Outcomes after repeat ablation of ventricular tachycardia in structural heart disease: An analysis from the International VT Ablation Center Collaborative Group

WS Tzou, R Tung, DS Frankel, Luigi Di Biase, P Santangeli, M Vaseghi, TJ Bunch, JP Weiss, VN Tholakanahalli, D Lakkireddy, R Vunnam, T Dickfeld, N Mathuria, U Tedrow, P Vergara, K Vakil, S Nakahara, JD Burkhardt, WG Stevenson, DJ CallansP Della Bella, Andrea Natale, K Shivkumar, FE Marchlinski, WH Sauer

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Abstract

Background Data evaluating repeat radiofrequency ablation ( > 1RFA) of ventricular tachycardia (VT) are limited. Objective The purpose of this study was to determine the safety and outcomes of VT > 1RFA in patients with structural heart disease. Methods Patients with structural heart disease undergoing VT RFA at 12 centers with data on prior RFA history were included. Characteristics and outcomes were compared between first-time (1RFA) and > 1RFA patients. Results Of 1990 patients, 740 had > 1RFA (mean 1.4 ± 0.9, range 1–10). > 1RFA vs 1RFA patients did not differ with regard to age (62 ± 13 years vs 62 ± 13 years), left ventricular ejection fraction (33% ± 13% vs 34% ± 13%), or sex (88% vs 87% men), but they more often were nonischemic (53% vs 41%), had implantable cardioverter–defibrillator shocks (70% vs 63%) or VT storm (38% vs 33%), and had been treated with amiodarone (55% vs 48%) or ≥2 antiarrhythmic drugs (22% vs 14%). > 1RFA procedures were longer (300 ± 122 minutes vs 266 ± 110 minutes), involved more epicardial access (41% vs 21%), induced VTs (2.4 ± 2.2 vs 1.9 ± 1.6) and only unmappable VTs (15% vs 9%), and VT was more often inducible after RFA (42% vs 33%, all P <.03). Total complications were higher for > 1RFA vs 1RFA (8% vs 5%, P <.01), mostly related to pericardial effusion (2.4% vs 1.3%, P =.07) and venous thrombosis (0.8% vs 0.2%, P =.06). VT recurrence was higher for > 1RFA vs 1RFA (29% vs 24%, P <.001). Survival was worse for > 1RFA vs 1RFA if VT recurred (67% vs 78%, P =.003) but was equivalent if successful (93% vs 92%, P =.96). Conclusion Patients requiring repeat VT ablation differ significantly from those undergoing first-time ablation. Despite more challenging ablation characteristics, VT-free survival after repeat ablations is encouraging. Mortality is comparable if VT does not recur after RFA at specialized centers. © 2017 Heart Rhythm Society
Original languageEnglish
Pages (from-to)991-997
Number of pages7
JournalHeart Rhythm
Volume14
Issue number7
DOIs
Publication statusPublished - 2017

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Ventricular Tachycardia
Heart Diseases
Amiodarone
Anti-Arrhythmia Agents
Stroke Volume
Shock
History
Safety
Survival
Mortality

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Outcomes after repeat ablation of ventricular tachycardia in structural heart disease: An analysis from the International VT Ablation Center Collaborative Group. / Tzou, WS; Tung, R; Frankel, DS; Di Biase, Luigi; Santangeli, P; Vaseghi, M; Bunch, TJ; Weiss, JP; Tholakanahalli, VN; Lakkireddy, D; Vunnam, R; Dickfeld, T; Mathuria, N; Tedrow, U; Vergara, P; Vakil, K; Nakahara, S; Burkhardt, JD; Stevenson, WG; Callans, DJ; Della Bella, P; Natale, Andrea; Shivkumar, K; Marchlinski, FE; Sauer, WH.

In: Heart Rhythm, Vol. 14, No. 7, 2017, p. 991-997.

Research output: Contribution to journalArticle

Tzou, WS, Tung, R, Frankel, DS, Di Biase, L, Santangeli, P, Vaseghi, M, Bunch, TJ, Weiss, JP, Tholakanahalli, VN, Lakkireddy, D, Vunnam, R, Dickfeld, T, Mathuria, N, Tedrow, U, Vergara, P, Vakil, K, Nakahara, S, Burkhardt, JD, Stevenson, WG, Callans, DJ, Della Bella, P, Natale, A, Shivkumar, K, Marchlinski, FE & Sauer, WH 2017, 'Outcomes after repeat ablation of ventricular tachycardia in structural heart disease: An analysis from the International VT Ablation Center Collaborative Group', Heart Rhythm, vol. 14, no. 7, pp. 991-997. https://doi.org/10.1016/j.hrthm.2017.03.008
Tzou, WS ; Tung, R ; Frankel, DS ; Di Biase, Luigi ; Santangeli, P ; Vaseghi, M ; Bunch, TJ ; Weiss, JP ; Tholakanahalli, VN ; Lakkireddy, D ; Vunnam, R ; Dickfeld, T ; Mathuria, N ; Tedrow, U ; Vergara, P ; Vakil, K ; Nakahara, S ; Burkhardt, JD ; Stevenson, WG ; Callans, DJ ; Della Bella, P ; Natale, Andrea ; Shivkumar, K ; Marchlinski, FE ; Sauer, WH. / Outcomes after repeat ablation of ventricular tachycardia in structural heart disease: An analysis from the International VT Ablation Center Collaborative Group. In: Heart Rhythm. 2017 ; Vol. 14, No. 7. pp. 991-997.
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title = "Outcomes after repeat ablation of ventricular tachycardia in structural heart disease: An analysis from the International VT Ablation Center Collaborative Group",
abstract = "Background Data evaluating repeat radiofrequency ablation ( > 1RFA) of ventricular tachycardia (VT) are limited. Objective The purpose of this study was to determine the safety and outcomes of VT > 1RFA in patients with structural heart disease. Methods Patients with structural heart disease undergoing VT RFA at 12 centers with data on prior RFA history were included. Characteristics and outcomes were compared between first-time (1RFA) and > 1RFA patients. Results Of 1990 patients, 740 had > 1RFA (mean 1.4 ± 0.9, range 1–10). > 1RFA vs 1RFA patients did not differ with regard to age (62 ± 13 years vs 62 ± 13 years), left ventricular ejection fraction (33{\%} ± 13{\%} vs 34{\%} ± 13{\%}), or sex (88{\%} vs 87{\%} men), but they more often were nonischemic (53{\%} vs 41{\%}), had implantable cardioverter–defibrillator shocks (70{\%} vs 63{\%}) or VT storm (38{\%} vs 33{\%}), and had been treated with amiodarone (55{\%} vs 48{\%}) or ≥2 antiarrhythmic drugs (22{\%} vs 14{\%}). > 1RFA procedures were longer (300 ± 122 minutes vs 266 ± 110 minutes), involved more epicardial access (41{\%} vs 21{\%}), induced VTs (2.4 ± 2.2 vs 1.9 ± 1.6) and only unmappable VTs (15{\%} vs 9{\%}), and VT was more often inducible after RFA (42{\%} vs 33{\%}, all P <.03). Total complications were higher for > 1RFA vs 1RFA (8{\%} vs 5{\%}, P <.01), mostly related to pericardial effusion (2.4{\%} vs 1.3{\%}, P =.07) and venous thrombosis (0.8{\%} vs 0.2{\%}, P =.06). VT recurrence was higher for > 1RFA vs 1RFA (29{\%} vs 24{\%}, P <.001). Survival was worse for > 1RFA vs 1RFA if VT recurred (67{\%} vs 78{\%}, P =.003) but was equivalent if successful (93{\%} vs 92{\%}, P =.96). Conclusion Patients requiring repeat VT ablation differ significantly from those undergoing first-time ablation. Despite more challenging ablation characteristics, VT-free survival after repeat ablations is encouraging. Mortality is comparable if VT does not recur after RFA at specialized centers. {\circledC} 2017 Heart Rhythm Society",
author = "WS Tzou and R Tung and DS Frankel and {Di Biase}, Luigi and P Santangeli and M Vaseghi and TJ Bunch and JP Weiss and VN Tholakanahalli and D Lakkireddy and R Vunnam and T Dickfeld and N Mathuria and U Tedrow and P Vergara and K Vakil and S Nakahara and JD Burkhardt and WG Stevenson and DJ Callans and {Della Bella}, P and Andrea Natale and K Shivkumar and FE Marchlinski and WH Sauer",
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TY - JOUR

T1 - Outcomes after repeat ablation of ventricular tachycardia in structural heart disease: An analysis from the International VT Ablation Center Collaborative Group

AU - Tzou, WS

AU - Tung, R

AU - Frankel, DS

AU - Di Biase, Luigi

AU - Santangeli, P

AU - Vaseghi, M

AU - Bunch, TJ

AU - Weiss, JP

AU - Tholakanahalli, VN

AU - Lakkireddy, D

AU - Vunnam, R

AU - Dickfeld, T

AU - Mathuria, N

AU - Tedrow, U

AU - Vergara, P

AU - Vakil, K

AU - Nakahara, S

AU - Burkhardt, JD

AU - Stevenson, WG

AU - Callans, DJ

AU - Della Bella, P

AU - Natale, Andrea

AU - Shivkumar, K

AU - Marchlinski, FE

AU - Sauer, WH

PY - 2017

Y1 - 2017

N2 - Background Data evaluating repeat radiofrequency ablation ( > 1RFA) of ventricular tachycardia (VT) are limited. Objective The purpose of this study was to determine the safety and outcomes of VT > 1RFA in patients with structural heart disease. Methods Patients with structural heart disease undergoing VT RFA at 12 centers with data on prior RFA history were included. Characteristics and outcomes were compared between first-time (1RFA) and > 1RFA patients. Results Of 1990 patients, 740 had > 1RFA (mean 1.4 ± 0.9, range 1–10). > 1RFA vs 1RFA patients did not differ with regard to age (62 ± 13 years vs 62 ± 13 years), left ventricular ejection fraction (33% ± 13% vs 34% ± 13%), or sex (88% vs 87% men), but they more often were nonischemic (53% vs 41%), had implantable cardioverter–defibrillator shocks (70% vs 63%) or VT storm (38% vs 33%), and had been treated with amiodarone (55% vs 48%) or ≥2 antiarrhythmic drugs (22% vs 14%). > 1RFA procedures were longer (300 ± 122 minutes vs 266 ± 110 minutes), involved more epicardial access (41% vs 21%), induced VTs (2.4 ± 2.2 vs 1.9 ± 1.6) and only unmappable VTs (15% vs 9%), and VT was more often inducible after RFA (42% vs 33%, all P <.03). Total complications were higher for > 1RFA vs 1RFA (8% vs 5%, P <.01), mostly related to pericardial effusion (2.4% vs 1.3%, P =.07) and venous thrombosis (0.8% vs 0.2%, P =.06). VT recurrence was higher for > 1RFA vs 1RFA (29% vs 24%, P <.001). Survival was worse for > 1RFA vs 1RFA if VT recurred (67% vs 78%, P =.003) but was equivalent if successful (93% vs 92%, P =.96). Conclusion Patients requiring repeat VT ablation differ significantly from those undergoing first-time ablation. Despite more challenging ablation characteristics, VT-free survival after repeat ablations is encouraging. Mortality is comparable if VT does not recur after RFA at specialized centers. © 2017 Heart Rhythm Society

AB - Background Data evaluating repeat radiofrequency ablation ( > 1RFA) of ventricular tachycardia (VT) are limited. Objective The purpose of this study was to determine the safety and outcomes of VT > 1RFA in patients with structural heart disease. Methods Patients with structural heart disease undergoing VT RFA at 12 centers with data on prior RFA history were included. Characteristics and outcomes were compared between first-time (1RFA) and > 1RFA patients. Results Of 1990 patients, 740 had > 1RFA (mean 1.4 ± 0.9, range 1–10). > 1RFA vs 1RFA patients did not differ with regard to age (62 ± 13 years vs 62 ± 13 years), left ventricular ejection fraction (33% ± 13% vs 34% ± 13%), or sex (88% vs 87% men), but they more often were nonischemic (53% vs 41%), had implantable cardioverter–defibrillator shocks (70% vs 63%) or VT storm (38% vs 33%), and had been treated with amiodarone (55% vs 48%) or ≥2 antiarrhythmic drugs (22% vs 14%). > 1RFA procedures were longer (300 ± 122 minutes vs 266 ± 110 minutes), involved more epicardial access (41% vs 21%), induced VTs (2.4 ± 2.2 vs 1.9 ± 1.6) and only unmappable VTs (15% vs 9%), and VT was more often inducible after RFA (42% vs 33%, all P <.03). Total complications were higher for > 1RFA vs 1RFA (8% vs 5%, P <.01), mostly related to pericardial effusion (2.4% vs 1.3%, P =.07) and venous thrombosis (0.8% vs 0.2%, P =.06). VT recurrence was higher for > 1RFA vs 1RFA (29% vs 24%, P <.001). Survival was worse for > 1RFA vs 1RFA if VT recurred (67% vs 78%, P =.003) but was equivalent if successful (93% vs 92%, P =.96). Conclusion Patients requiring repeat VT ablation differ significantly from those undergoing first-time ablation. Despite more challenging ablation characteristics, VT-free survival after repeat ablations is encouraging. Mortality is comparable if VT does not recur after RFA at specialized centers. © 2017 Heart Rhythm Society

U2 - 10.1016/j.hrthm.2017.03.008

DO - 10.1016/j.hrthm.2017.03.008

M3 - Article

VL - 14

SP - 991

EP - 997

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

IS - 7

ER -