TY - JOUR
T1 - Catheter ablation of ventricular tachycardia in patients with prior cardiac surgery
T2 - An analysis from the International VT Ablation Center Collaborative Group
AU - Aguilar, Martin
AU - Tedrow, Usha B.
AU - Tzou, Wendy S.
AU - Tung, Roderick
AU - Frankel, David S.
AU - Santangeli, Pasquale
AU - Vaseghi, Marmar
AU - Bunch, T. Jared
AU - Di Biase, Luigi
AU - Tholakanahalli, Venkatakrishna N.
AU - Lakkireddy, Dhanunjaya
AU - Dickfeld, Timm
AU - Weiss, J. Peter
AU - Mathuria, Nilesh
AU - Vergara, Pasquale
AU - Nakahara, Shiro
AU - Bradfield, Jason S.
AU - Burkhardt, J. David
AU - Stevenson, William G.
AU - Callans, David J.
AU - Della Bella, Paolo
AU - Natale, Andrea
AU - Shivkumar, Kalyanam
AU - Marchlinski, Francis E.
AU - Sauer, William H.
N1 - Publisher Copyright:
© 2020 Wiley Periodicals LLC
PY - 2021/2
Y1 - 2021/2
N2 - Introduction: Patients with prior cardiac surgery may represent a subgroup of patients with ventricular tachycardia (VT) that may be more difficult to control with catheter ablation. Methods: We evaluated 1901 patients with ischemic and nonischemic cardiomyopathy who underwent VT ablation at 12 centers. Clinical characteristics and VT radiofrequency ablation procedural outcomes were assessed and compared between those with and without prior cardiac surgery. Kaplan–Meier analysis was used to estimate freedom from recurrent VT and survival. Results: There were 578 subjects (30.4%) with prior cardiac surgery identified in the cohort. Those with prior cardiac surgery were older (66.4 ± 11.0 years vs. 60.5 ± 13.9 years, p <.01), with lower left ventricular ejection fraction (30.2 ± 11.5% vs. 34.8 ± 13.6%, p <.01) and more ischemic heart disease (82.5% vs. 39.3%, p <.01) but less likely to undergo epicardial mapping or ablation (9.0% vs. 38.1%, p<.01) compared to those without prior surgery. When epicardial mapping was performed, a significantly greater proportion required surgical intervention for access (19/52 [36.5%] vs. 14/504 [2.8%]; p <.01). Procedural complications, including epicardial access-related complications, were lower (5.7% vs. 7.0%, p <.01) in patients with versus without prior cardiac surgery. VT-free survival (75.1% vs. 74.1%, p =.805) and survival (86.5% vs. 87.9%, p =.397) were not different between those with and without prior heart surgery, regardless of etiology of cardiomyopathy. VT recurrence was associated with increased mortality in patients with and without prior cardiac surgery. Conclusion: Despite different clinical characteristics and fewer epicardial procedures, the safety and efficacy of VT ablation in patients with prior cardiac surgery is similar to others in this cohort. The incremental yield of epicardial mapping in predominant ischemic cardiomyopathy population prior heart surgery may be low but appears safe in experienced centers.
AB - Introduction: Patients with prior cardiac surgery may represent a subgroup of patients with ventricular tachycardia (VT) that may be more difficult to control with catheter ablation. Methods: We evaluated 1901 patients with ischemic and nonischemic cardiomyopathy who underwent VT ablation at 12 centers. Clinical characteristics and VT radiofrequency ablation procedural outcomes were assessed and compared between those with and without prior cardiac surgery. Kaplan–Meier analysis was used to estimate freedom from recurrent VT and survival. Results: There were 578 subjects (30.4%) with prior cardiac surgery identified in the cohort. Those with prior cardiac surgery were older (66.4 ± 11.0 years vs. 60.5 ± 13.9 years, p <.01), with lower left ventricular ejection fraction (30.2 ± 11.5% vs. 34.8 ± 13.6%, p <.01) and more ischemic heart disease (82.5% vs. 39.3%, p <.01) but less likely to undergo epicardial mapping or ablation (9.0% vs. 38.1%, p<.01) compared to those without prior surgery. When epicardial mapping was performed, a significantly greater proportion required surgical intervention for access (19/52 [36.5%] vs. 14/504 [2.8%]; p <.01). Procedural complications, including epicardial access-related complications, were lower (5.7% vs. 7.0%, p <.01) in patients with versus without prior cardiac surgery. VT-free survival (75.1% vs. 74.1%, p =.805) and survival (86.5% vs. 87.9%, p =.397) were not different between those with and without prior heart surgery, regardless of etiology of cardiomyopathy. VT recurrence was associated with increased mortality in patients with and without prior cardiac surgery. Conclusion: Despite different clinical characteristics and fewer epicardial procedures, the safety and efficacy of VT ablation in patients with prior cardiac surgery is similar to others in this cohort. The incremental yield of epicardial mapping in predominant ischemic cardiomyopathy population prior heart surgery may be low but appears safe in experienced centers.
KW - ablation outcomes
KW - cardiac surgery
KW - catheter ablation
KW - ventricular tachycardia
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U2 - 10.1111/jce.14849
DO - 10.1111/jce.14849
M3 - Article
C2 - 33355965
AN - SCOPUS:85099980234
SN - 1045-3873
VL - 32
SP - 409
EP - 416
JO - Journal of cardiovascular electrophysiology
JF - Journal of cardiovascular electrophysiology
IS - 2
ER -