TY - JOUR
T1 - Prognostic Impact of the Timing of Recurrence of Infarct-Related Ventricular Tachycardia after Catheter Ablation
AU - Siontis, Konstantinos C.
AU - Kim, Hyungjin Myra
AU - Stevenson, William G.
AU - Fujii, Akira
AU - Della Bella, Paolo
AU - Vergara, Pasquale
AU - Shivkumar, Kalyanam
AU - Tung, Roderick
AU - Do, Duc H.
AU - Daoud, Emile G.
AU - Okabe, Toshimasa
AU - Zeppenfeld, Katja
AU - De Riva Silva, Marta
AU - Hindricks, Gerhard
AU - Arya, Arash
AU - Weber, Alexander
AU - Kuck, Karl Heinz
AU - Metzner, Andreas
AU - Mathew, Shibu
AU - Riedl, Johannes
AU - Yokokawa, Miki
AU - Jongnarangsin, Krit
AU - Latchamsetty, Rakesh
AU - Morady, Fred
AU - Bogun, Frank M.
N1 - Publisher Copyright:
© 2016 American Heart Association, Inc.
PY - 2016/12/1
Y1 - 2016/12/1
N2 - 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.
AB - 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.
KW - catheter ablation
KW - myocardial infarction
KW - prognosis
KW - recurrence
KW - ventricular tachycardia
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U2 - 10.1161/CIRCEP.116.004432
DO - 10.1161/CIRCEP.116.004432
M3 - Article
C2 - 27923805
AN - SCOPUS:85006975184
SN - 1941-3149
VL - 9
JO - Circulation: Arrhythmia and Electrophysiology
JF - Circulation: Arrhythmia and Electrophysiology
IS - 12
M1 - e004432
ER -