Prognostic Impact of the Timing of Recurrence of Infarct-Related Ventricular Tachycardia after Catheter Ablation

Konstantinos C. Siontis, Hyungjin Myra Kim, William G. Stevenson, Akira Fujii, Paolo Della Bella, Pasquale Vergara, Kalyanam Shivkumar, Roderick Tung, Duc H. Do, Emile G. Daoud, Toshimasa Okabe, Katja Zeppenfeld, Marta De Riva Silva, Gerhard Hindricks, Arash Arya, Alexander Weber, Karl Heinz Kuck, Andreas Metzner, Shibu Mathew, Johannes RiedlMiki Yokokawa, Krit Jongnarangsin, Rakesh Latchamsetty, Fred Morady, Frank M. Bogun

Research output: Contribution to journalArticlepeer-review

Abstract

Background - Recurrence of ventricular tachycardia (VT) after ablation in patients with previous myocardial infarction is associated with adverse prognosis. However, the impact of the timing of VT recurrence on outcomes is unclear. Methods and Results - We analyzed data from a multicenter collaborative database of patients who underwent catheter ablation for infarct-related VT. Multivariable Cox regression analyses investigated the effect of the timing of VT recurrence on the composite outcome of death or heart transplantation using VT recurrence as a time-varying covariate. A total of 1412 patients were included (92% men; age: 66.7±10.7 years), and 605 patients (42.8%) had a recurrence after median 116 days (188 [31.1%] within 1 month, 239 [39.5%] between 1 and 12 months, and 178 [29.4%] after 12 months). At median follow-up of 670 days, 375 patients (26.6%) experienced death or heart transplantation. The median time from recurrence to death or heart transplantation was 65 and 198.5 days in patients with recurrence ≤30 days and >30 days post ablation, respectively. The adjusted hazard ratio (95% confidence interval) for the effect of VT recurrence occurring immediately post ablation on death or heart transplantation was 3.45 (2.33-5.11) in reference to no recurrence. However, the magnitude of this effect decreased statistically significantly (P<0.001) as recurrence occurred later in the follow-up period. The respective risk estimates for VT recurrence at 30 days, 6 months, 1 year, and 2 years were 3.36 (2.29-4.93), 2.94 (2.09-4.14), 2.50 (1.85-3.37), and 1.81 (1.37-2.40). Conclusions - VT recurrence post ablation is associated with a mortality risk that is highest soon after the ablation and decreases gradually thereafter.

Original languageEnglish
Article numbere004432
JournalCirculation: Arrhythmia and Electrophysiology
Volume9
Issue number12
DOIs
Publication statusPublished - Dec 1 2016

Keywords

  • catheter ablation
  • myocardial infarction
  • prognosis
  • recurrence
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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