Successful ventricular tachycardia ablation in patients with electrical storm reduces recurrences and improves survival

P Vergara, R Tung, M Vaseghi, C Brombin, D Frankel, L Di Biase, K Nagashima, U Tedrow, WS Tzou, WH Sauer, N Mathuria, S Nakahara, K Vakil, V Tholakanahalli, TJ Bunch, JP Weiss, T Dickfeld, R Vunnam, D Lakireddy, JD BurkhardtA Correra, P Santangeli, D Callans, A Natale, F Marchlinski, WG Stevenson, K Shivkumar, P Della Bella

Research output: Contribution to journalArticle

Abstract

Objective: The purpose of this study was to evaluate the characteristics and outcome of patients undergoing ablation after electrical storm (ES). Methods: Clinical and procedural characteristics, ventricular tachycardia (VT) recurrence, and mortality rates from 1940 patients undergoing VT ablation were compared between patients with and without ES. Results: The group of 677 patients with ES (34.9%) were older, were more frequently men, and had a lower ejection fraction, more advanced heart failure, and a higher prevalence of cardiovascular comorbidities as compared with those without ES (86.1% patients with ES had ≥2 comorbidities vs 71.4%; P < .001). Patients with ES had more inducible VTs (2.5 ± 1.8 vs 1.9 ± 1.9; P < .001), required longer procedures (296.1 ± 119.1 minutes vs 265.7 ± 110.3 minutes; P < .001), and had a higher in-hospital mortality (42 deaths [6.2%] vs 18 deaths [1.4%] ; P < .001). At 1-year follow-up, patients with ES experienced a higher risk of VT recurrence and mortality (32.1% vs 22.6% and 20.1% vs 8.5%; long-rank, P < .001 for both). Among patients with ES, those without any inducible VT after ablation had a higher survival rate (86.3%) than did those with nonclinical VTs only (72.9%), those with clinical VTs inducible at programmed electrical stimulation (51.2%), and not-tested patients (65.0%) (long-rank, P < .001 for all). In multivariate analysis, ES remained an independent predictor of in-hospital mortality, VT recurrence, and 1-year mortality (P < .001). Conclusion: Patients with ES have a high risk of VT recurrence and mortality. Patient and procedure characteristics are consistent with advanced cardiac disease and longer and more complex procedures. In patients with ES, acute procedural success is associated with a significant reduction in VT recurrence and improved 1-year survival. © 2017 Heart Rhythm Society.
Original languageEnglish
Pages (from-to)48-55
Number of pages8
JournalHeart Rhythm
Volume15
Issue number1
DOIs
Publication statusPublished - 2018

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Ventricular Tachycardia
Recurrence
Survival
Mortality
Hospital Mortality
Comorbidity
Electric Stimulation
Heart Diseases
Multivariate Analysis
Survival Rate
Heart Failure

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Successful ventricular tachycardia ablation in patients with electrical storm reduces recurrences and improves survival. / Vergara, P; Tung, R; Vaseghi, M; Brombin, C; Frankel, D; Di Biase, L; Nagashima, K; Tedrow, U; Tzou, WS; Sauer, WH; Mathuria, N; Nakahara, S; Vakil, K; Tholakanahalli, V; Bunch, TJ; Weiss, JP; Dickfeld, T; Vunnam, R; Lakireddy, D; Burkhardt, JD; Correra, A; Santangeli, P; Callans, D; Natale, A; Marchlinski, F; Stevenson, WG; Shivkumar, K; Della Bella, P.

In: Heart Rhythm, Vol. 15, No. 1, 2018, p. 48-55.

Research output: Contribution to journalArticle

Vergara, P, Tung, R, Vaseghi, M, Brombin, C, Frankel, D, Di Biase, L, Nagashima, K, Tedrow, U, Tzou, WS, Sauer, WH, Mathuria, N, Nakahara, S, Vakil, K, Tholakanahalli, V, Bunch, TJ, Weiss, JP, Dickfeld, T, Vunnam, R, Lakireddy, D, Burkhardt, JD, Correra, A, Santangeli, P, Callans, D, Natale, A, Marchlinski, F, Stevenson, WG, Shivkumar, K & Della Bella, P 2018, 'Successful ventricular tachycardia ablation in patients with electrical storm reduces recurrences and improves survival', Heart Rhythm, vol. 15, no. 1, pp. 48-55. https://doi.org/10.1016/j.hrthm.2017.08.022
Vergara, P ; Tung, R ; Vaseghi, M ; Brombin, C ; Frankel, D ; Di Biase, L ; Nagashima, K ; Tedrow, U ; Tzou, WS ; Sauer, WH ; Mathuria, N ; Nakahara, S ; Vakil, K ; Tholakanahalli, V ; Bunch, TJ ; Weiss, JP ; Dickfeld, T ; Vunnam, R ; Lakireddy, D ; Burkhardt, JD ; Correra, A ; Santangeli, P ; Callans, D ; Natale, A ; Marchlinski, F ; Stevenson, WG ; Shivkumar, K ; Della Bella, P. / Successful ventricular tachycardia ablation in patients with electrical storm reduces recurrences and improves survival. In: Heart Rhythm. 2018 ; Vol. 15, No. 1. pp. 48-55.
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abstract = "Objective: The purpose of this study was to evaluate the characteristics and outcome of patients undergoing ablation after electrical storm (ES). Methods: Clinical and procedural characteristics, ventricular tachycardia (VT) recurrence, and mortality rates from 1940 patients undergoing VT ablation were compared between patients with and without ES. Results: The group of 677 patients with ES (34.9{\%}) were older, were more frequently men, and had a lower ejection fraction, more advanced heart failure, and a higher prevalence of cardiovascular comorbidities as compared with those without ES (86.1{\%} patients with ES had ≥2 comorbidities vs 71.4{\%}; P < .001). Patients with ES had more inducible VTs (2.5 ± 1.8 vs 1.9 ± 1.9; P < .001), required longer procedures (296.1 ± 119.1 minutes vs 265.7 ± 110.3 minutes; P < .001), and had a higher in-hospital mortality (42 deaths [6.2{\%}] vs 18 deaths [1.4{\%}] ; P < .001). At 1-year follow-up, patients with ES experienced a higher risk of VT recurrence and mortality (32.1{\%} vs 22.6{\%} and 20.1{\%} vs 8.5{\%}; long-rank, P < .001 for both). Among patients with ES, those without any inducible VT after ablation had a higher survival rate (86.3{\%}) than did those with nonclinical VTs only (72.9{\%}), those with clinical VTs inducible at programmed electrical stimulation (51.2{\%}), and not-tested patients (65.0{\%}) (long-rank, P < .001 for all). In multivariate analysis, ES remained an independent predictor of in-hospital mortality, VT recurrence, and 1-year mortality (P < .001). Conclusion: Patients with ES have a high risk of VT recurrence and mortality. Patient and procedure characteristics are consistent with advanced cardiac disease and longer and more complex procedures. In patients with ES, acute procedural success is associated with a significant reduction in VT recurrence and improved 1-year survival. {\circledC} 2017 Heart Rhythm Society.",
author = "P Vergara and R Tung and M Vaseghi and C Brombin and D Frankel and {Di Biase}, L and K Nagashima and U Tedrow and WS Tzou and WH Sauer and N Mathuria and S Nakahara and K Vakil and V Tholakanahalli and TJ Bunch and JP Weiss and T Dickfeld and R Vunnam and D Lakireddy and JD Burkhardt and A Correra and P Santangeli and D Callans and A Natale and F Marchlinski and WG Stevenson and K Shivkumar and {Della Bella}, P",
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T1 - Successful ventricular tachycardia ablation in patients with electrical storm reduces recurrences and improves survival

AU - Vergara, P

AU - Tung, R

AU - Vaseghi, M

AU - Brombin, C

AU - Frankel, D

AU - Di Biase, L

AU - Nagashima, K

AU - Tedrow, U

AU - Tzou, WS

AU - Sauer, WH

AU - Mathuria, N

AU - Nakahara, S

AU - Vakil, K

AU - Tholakanahalli, V

AU - Bunch, TJ

AU - Weiss, JP

AU - Dickfeld, T

AU - Vunnam, R

AU - Lakireddy, D

AU - Burkhardt, JD

AU - Correra, A

AU - Santangeli, P

AU - Callans, D

AU - Natale, A

AU - Marchlinski, F

AU - Stevenson, WG

AU - Shivkumar, K

AU - Della Bella, P

PY - 2018

Y1 - 2018

N2 - Objective: The purpose of this study was to evaluate the characteristics and outcome of patients undergoing ablation after electrical storm (ES). Methods: Clinical and procedural characteristics, ventricular tachycardia (VT) recurrence, and mortality rates from 1940 patients undergoing VT ablation were compared between patients with and without ES. Results: The group of 677 patients with ES (34.9%) were older, were more frequently men, and had a lower ejection fraction, more advanced heart failure, and a higher prevalence of cardiovascular comorbidities as compared with those without ES (86.1% patients with ES had ≥2 comorbidities vs 71.4%; P < .001). Patients with ES had more inducible VTs (2.5 ± 1.8 vs 1.9 ± 1.9; P < .001), required longer procedures (296.1 ± 119.1 minutes vs 265.7 ± 110.3 minutes; P < .001), and had a higher in-hospital mortality (42 deaths [6.2%] vs 18 deaths [1.4%] ; P < .001). At 1-year follow-up, patients with ES experienced a higher risk of VT recurrence and mortality (32.1% vs 22.6% and 20.1% vs 8.5%; long-rank, P < .001 for both). Among patients with ES, those without any inducible VT after ablation had a higher survival rate (86.3%) than did those with nonclinical VTs only (72.9%), those with clinical VTs inducible at programmed electrical stimulation (51.2%), and not-tested patients (65.0%) (long-rank, P < .001 for all). In multivariate analysis, ES remained an independent predictor of in-hospital mortality, VT recurrence, and 1-year mortality (P < .001). Conclusion: Patients with ES have a high risk of VT recurrence and mortality. Patient and procedure characteristics are consistent with advanced cardiac disease and longer and more complex procedures. In patients with ES, acute procedural success is associated with a significant reduction in VT recurrence and improved 1-year survival. © 2017 Heart Rhythm Society.

AB - Objective: The purpose of this study was to evaluate the characteristics and outcome of patients undergoing ablation after electrical storm (ES). Methods: Clinical and procedural characteristics, ventricular tachycardia (VT) recurrence, and mortality rates from 1940 patients undergoing VT ablation were compared between patients with and without ES. Results: The group of 677 patients with ES (34.9%) were older, were more frequently men, and had a lower ejection fraction, more advanced heart failure, and a higher prevalence of cardiovascular comorbidities as compared with those without ES (86.1% patients with ES had ≥2 comorbidities vs 71.4%; P < .001). Patients with ES had more inducible VTs (2.5 ± 1.8 vs 1.9 ± 1.9; P < .001), required longer procedures (296.1 ± 119.1 minutes vs 265.7 ± 110.3 minutes; P < .001), and had a higher in-hospital mortality (42 deaths [6.2%] vs 18 deaths [1.4%] ; P < .001). At 1-year follow-up, patients with ES experienced a higher risk of VT recurrence and mortality (32.1% vs 22.6% and 20.1% vs 8.5%; long-rank, P < .001 for both). Among patients with ES, those without any inducible VT after ablation had a higher survival rate (86.3%) than did those with nonclinical VTs only (72.9%), those with clinical VTs inducible at programmed electrical stimulation (51.2%), and not-tested patients (65.0%) (long-rank, P < .001 for all). In multivariate analysis, ES remained an independent predictor of in-hospital mortality, VT recurrence, and 1-year mortality (P < .001). Conclusion: Patients with ES have a high risk of VT recurrence and mortality. Patient and procedure characteristics are consistent with advanced cardiac disease and longer and more complex procedures. In patients with ES, acute procedural success is associated with a significant reduction in VT recurrence and improved 1-year survival. © 2017 Heart Rhythm Society.

U2 - 10.1016/j.hrthm.2017.08.022

DO - 10.1016/j.hrthm.2017.08.022

M3 - Article

VL - 15

SP - 48

EP - 55

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

IS - 1

ER -