Complications and mortality after catheter ablation of ventricular arrhythmias: risk in VT ablation (RIVA) score

Abstract Aims Catheter ablation of ventricular arrhythmias (VA) has proven to be an effective therapeutic option for secondary arrhythmia prophylaxis. We sought to assess the procedural efficacy, safety and in-hospital mortality of a large patient cohort with and without structural heart disease undergoing VA ablation. Methods A total of 1417 patients (804 patients with structural heart disease) undergoing 1792 endo- and epicardial procedures were analyzed. Multivariable risk factor analysis for occurrence of major complications and intrahospital mortality was obtained and a score to allow preprocedural risk assessment for patients undergoing VA ablation procedures was established. Results Major complication occurred in 4.4% of all procedures and significantly more often in patients with structural heart disease than in structurally normal hearts (6.0 vs. 1.8%). The frequency of these periprocedural complications was significantly different between procedures with sole right ventricular and a combination of RV and LV access (0.5 vs. 3.1%). The most common complication was cardiac tamponade in 46 cases (3.0%). Intrahospital death was observed in 32 patients (1.8%). Logistic regression model revealed presence of ischemic heart disease, epicardial ablation, presence of oral anticoagulation or dual antiplatelet therapy as independent risk factors for the occurrence of complications or intrahospital death, while a history of previous heart surgery was an independent predictor with a decreased risk. Based on this analysis a risk score incorporating 5 standard variables was established to predict the occurrence of complications and intrahospital mortality. Conclusions Safety of VA catheter ablation mainly relies on patient baseline characteristics and the type of access into the ventricles or epicardial space.

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Minimising radiation exposure in catheter ablation of ventricular arrhythmias

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02120-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Matevž Jan ◽

David Žižek ◽

Tine Prolič Kalinšek ◽

Dimitrij Kuhelj ◽

Primož Trunk ◽

...

Keyword(s):

Catheter Ablation ◽

Radiation Exposure ◽

Ventricular Arrhythmias ◽

Major Complication ◽

Structural Heart Disease ◽

Left Ventricular ◽

Complex Nature ◽

Group 2 ◽

Procedural Outcomes ◽

Group 1

Abstract Background Conventional fluoroscopy guided catheter ablation (CA) is an established treatment option for ventricular arrhythmias (VAs). However, with the complex nature of most procedures, patients and staff bare an increased radiation exposure. Near-zero or zero-fluoroscopy CA is an alternative method which could substantially reduce or even eliminate the radiation dose. Our aim was to analyse procedural outcomes with fluoroscopy minimising approach for treatment of VAs in patients with structurally normal hearts (SNH) and structural heart disease (SHD). Methods Fifty-two (age 53.4 ± 17.8 years, 38 male, 14 female) consecutive patients who underwent CA of VAs in our institution between May 2018 and December 2019 were included. Procedures were performed primarily with the aid of the three-dimensional electro-anatomical mapping system and intra-cardiac echocardiography. Fluoroscopy was considered only in left ventricular (LV) summit mapping for coronary angiography and when epicardial approach was planned. Acute and long-term procedural outcomes were analysed. Results Sixty CA procedures were performed. Twenty-five patients had SHD-related VAs (Group 1) and 27 patients had SNH (Group 2). While Group 1 had significantly higher total procedural time (256.9 ± 71.7 vs 123.6 ± 42.2 min; p < 0.001) compared to Group 2, overall procedural success rate [77.4% (24/31) vs 89.7% (26/29); p = 0.20)] and recurrence rate after the first procedure [8/25, (32%) vs 8/27, (29.6%); p = 0.85] were similar in both groups. Fluoroscopy was used in 3 procedures in Group 1 where epicardial approach was needed and in 4 procedures in Group 2 where LV summit VAs were ablated. Overall procedure-related major complication rate was 5%. Conclusions Fluoroscopy minimising approach for CA of VAs is feasible and safe in patients with SHD and SNH. Fluoroscopy could not be completely abolished in VAs with epicardial and LV summit substrate location.

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Sustained monomorphic ventricular tachycardia: the role of catheter ablation

ESC CardioMed ◽

10.1093/med/9780198784906.003.0539 ◽

2018 ◽

pp. 2279-2288

Author(s):

Tilman Maurer ◽

William G. Stevenson ◽

Karl-Heinz Kuck

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Catheter Ablation ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Therapeutic Option ◽

Structural Heart Disease ◽

Premature Ventricular Contractions ◽

Monomorphic Ventricular Tachycardia ◽

Premature Beats

Monomorphic ventricular tachycardia (VT) may occur in the presence or absence of structural heart disease. The standard therapy for patients with structural heart disease at high risk of sudden cardiac death due to VT is the implantable cardioverter defibrillator (ICD). While ICDs effectively terminate VT and prevent sudden cardiac death, they do not prevent recurrent episodes of VT, since the underlying arrhythmogenic substrate remains unchanged. However, shocks from an ICD increase mortality and impair quality of life. These limitations as well as continuous advancements in technology have made catheter ablation an important treatment strategy for patients with structural heart disease presenting with VT. Idiopathic ventricular arrhythmias include premature ventricular contractions and VT occurring in the absence of overt structural heart disease. In this setting, catheter ablation has evolved as the primary therapeutic option for symptomatic ventricular premature beats and sustained VTs and is curative in most cases. This chapter presents an overview of the principles of invasive diagnosis and treatment of monomorphic VTs in patients with and without structural heart disease and delineates the clinical outcome of catheter ablation. Finally, the chapter provides an outlook to the future, discussing potential directions and upcoming developments in the field of catheter ablation of monomorphic VT.

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Ventricular Arrhythmia Burden as a Marker of Success Following Catheter Ablation of Ventricular Arrhythmias in Patients with Structural Heart Disease

Korean Circulation Journal ◽

10.4070/kcj.2020.0415 ◽

2021 ◽

Vol 51 ◽

Author(s):

Richard Bennett ◽

Samual Turnbull ◽

Yasuhito Kotake ◽

Timothy Campbell ◽

Saurabh Kumar

Keyword(s):

Heart Disease ◽

Catheter Ablation ◽

Ventricular Arrhythmia ◽

Ventricular Arrhythmias ◽

Structural Heart Disease

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Limitations and Challenges in Mapping Ventricular Tachycardia: New Technologies and Future Directions

Arrhythmia & Electrophysiology Review ◽

10.15420/aer.2017.20.1 ◽

2017 ◽

Vol 6 (3) ◽

pp. 118 ◽

Cited By ~ 12

Author(s):

Adam J Graham ◽

Michele Orini ◽

Pier D Lambiase ◽

◽

...

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Catheter Ablation ◽

New Technologies ◽

Therapeutic Option ◽

Myocardial Damage ◽

Structural Heart Disease ◽

Mortality And Morbidity ◽

Ventricular Tachycardia Ablation ◽

Life Saving

Recurrent episodes of ventricular tachycardia in patients with structural heart disease are associated with increased mortality and morbidity, despite the life-saving benefits of implantable cardiac defibrillators. Reducing implantable cardiac defibrillator therapies is important, as recurrent shocks can cause increased myocardial damage and stunning, despite the conversion of ventricular tachycardia/ventricular fibrillation. Catheter ablation has emerged as a potential therapeutic option either for primary or secondary prevention of these arrhythmias, particularly in post-myocardial infarction cases where the substrate is well defined. However, the outcomes of catheter ablation of ventricular tachycardia in structural heart disease remain unsatisfactory in comparison with other electrophysiological procedures. The disappointing efficacy of ventricular tachycardia ablation in structural heart disease is multifactorial. In this review, we discuss the issues surrounding this and examine the limitations of current mapping approaches, as well as newer technologies that might help address them.

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Catheter ablation of ventricular arrhythmias and in-hospital mortality: insights from the German-wide Helios hospital network of 5052 cases

EP Europace ◽

10.1093/europace/euz260 ◽

2019 ◽

Cited By ~ 1

Author(s):

Sebastian König ◽

Laura Ueberham ◽

René Müller-Röthing ◽

Michael Wiedemann ◽

Michael Ulbrich ◽

...

Keyword(s):

Heart Disease ◽

Catheter Ablation ◽

Hospital Mortality ◽

Ventricular Arrhythmias ◽

Emergency Admission ◽

Structural Heart Disease ◽

Mortality Rates ◽

Hospital Death ◽

Premature Ventricular Contractions ◽

Hospital Transfer

Abstract Aims Catheter ablation (CA) of ventricular arrhythmias is one of the most challenging electrophysiological interventions with an increasing use over the last years. Several benefits must be weighed against the risk of potentially life-threatening complications which necessitates a steady reevaluation of safety endpoints. Therefore, the aims of this study were (i) to investigate overall in-hospital mortality in patients undergoing such procedures and (ii) to identify variables associated with in-hospital mortality in a German-wide hospital network. Methods and results Between January 2010 and September 2018, administrative data provided by 85 Helios hospitals were screened for patients with main or secondary discharge diagnosis of ventricular tachycardia (VT) or premature ventricular contractions (PVCs) in combination with an arrhythmia-related CA using ICD- and OPS codes. In 5052 cases (mean age 60.9 ± 14.3 years, 30.1% female) of 30 different hospitals, in-hospital mortality was 1.27% with a higher mortality in patients ablated for VT (1.99%, n = 2, 955) compared to PVC (0.24%, n = 2, 097, P < 0.01). Mortality rates were 2.06% in patients with ischaemic heart disease (IHD, n = 2, 137), 1.47% in patients with non-ischaemic structural heart disease (NIHD, n = 1, 224), and 0.12% in patients without structural heart disease (NSHD, n = 1, 691). Considering different types of hospital admission, mortality rates were 0.35% after elective (n = 2, 825), 1.60% after emergency admission/hospital transfer <24 h (n = 1, 314) and 3.72% following delayed hospital transfer >24 h after initial admission (n = 861, P < 0.01 vs. elective admission and emergency admission/hospital transfer <24 h). In multivariable analysis, a delayed hospital transfer >24 h [odds ratio (OR) 2.28, 95% confidence interval (CI) 1.59–3.28, P < 0.01], the occurrence of procedure-related major adverse events (OR 6.81, 95% CI 2.90–16.0, P < 0.01), Charlson Comorbidity Index (CCI, OR 2.39, 95% CI 1.56–3.66, P < 0.01) and its components congestive heart failure (OR 8.04, 95% CI 1.71–37.8, P < 0.01), and diabetes mellitus (OR 1.59, 95% CI 1.13–2.22, P < 0.01) were significantly associated with in-hospital death. Conclusions We reported in-hospital mortality rates after CA of ventricular arrhythmias in the largest multicentre, administrative dataset in Germany which can be implemented in quality management programs. Aside from comorbidities, a delayed hospital transfer to a CA performing centre is associated with an increased in-hospital mortality. This deserves further studies to determine the optimal management strategy.

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Comparison of Complications of Catheter Ablation for Ventricular Arrhythmias in Adults With Versus Without Structural Heart Disease

The American Journal of Cardiology ◽

10.1016/j.amjcard.2018.07.001 ◽

2018 ◽

Vol 122 (8) ◽

pp. 1345-1351 ◽

Cited By ~ 5

Author(s):

Gbolahan O. Ogunbayo ◽

Richard Charnigo ◽

Yousef Darrat ◽

Jignesh Shah ◽

Ripa Patel ◽

...

Keyword(s):

Heart Disease ◽

Catheter Ablation ◽

Ventricular Arrhythmias ◽

Structural Heart Disease

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Catheter Ablation for Ventricular Arrhythmias

Arrhythmia & Electrophysiology Review ◽

10.15420/aer.2013.2.1.45 ◽

2013 ◽

Vol 2 (1) ◽

pp. 45 ◽

Cited By ~ 2

Author(s):

Eyal Nof ◽

William G Stevenson ◽

Roy M John ◽

◽

...

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Catheter Ablation ◽

Ventricular Arrhythmias ◽

Structural Heart Disease ◽

Success Rates ◽

Effective Treatment Option ◽

Cardioverter Defibrillator ◽

Mapping Techniques ◽

Catheter Technology

Catheter ablation has emerged as an important and effective treatment option for many recurrent ventricular arrhythmias. The approach to ablation and the risks and outcomes are largely determined by the nature of the severity and type of underlying heart disease. In patients with structural heart disease, catheter ablation can effectively reduce ventricular tachycardia (VT) episodes and implantable cardioverter defibrillator (ICD) shocks. For VT and symptomatic premature ventricular beats that occur in the absence of structural heart disease, catheter ablation is often effective as the sole therapy. Advances in catheter technology, imaging and mapping techniques have improved success rates for ablation. This review discusses current approaches to mapping and ablation for ventricular arrhythmias.

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