scholarly journals Preventive Ventricular Tachycardia Ablation in Patients with Ischaemic Cardiomyopathy: Meta-analysis of Randomised Trials

2019 ◽  
Vol 8 (3) ◽  
pp. 173-179 ◽  
Author(s):  
Roland R Tilz ◽  
Charlotte Eitel ◽  
Evgeny Lyan ◽  
Kivanc Yalin ◽  
Spyridon Liosis ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Secondary Prevention ◽  
Meta Analysis ◽  
Randomised Trials ◽  
Icd Implantation ◽  
Icd Therapy ◽  
Number Of Patients ◽  
Significant Difference ◽  
Vt Ablation

Catheter ablation of ventricular tachycardia (VT) aims to treat the underlying arrhythmia substrate to prevent ICD therapies. The aim of this meta-analysis was to assess the safety and efficacy of VT ablation prior to or at the time of secondary prevention ICD implantation in patients with coronary artery disease, as compared with deferred VT ablation. Based on a systematic literature search, three randomised trials were considered eligible for inclusion in this analysis, and data on the number of patients with appropriate ICD shocks, appropriate ICD therapy, arrhythmic storm, death and major complications were extracted from each study. On pooled analysis, there was a significant reduction of appropriate ICD shocks (OR 2.58; 95% CI [1.54–4.34]; p<0.001) and appropriate ICD therapies (OR 2.04; 95% CI [1.15–3.61]; p=0.015) in patients undergoing VT ablation at the time of ICD implantation without significant differences with respect to complications (OR 1.39; 95% CI [0.43–4.51]; p=0.581). Mortality did not differ between both groups (OR 1.30; 95% CI [0.60–2.45]; p=0.422). Preventive catheter ablation of VT in patients with coronary heart disease at the time of secondary prevention ICD implantation results in a significant reduction of appropriate ICD shocks and any appropriate ICD therapy compared with patients without or with deferred VT ablation. No significant difference with respect to complications or mortality was observed between both treatment strategies.

scholarly journals Subcutaneous ICD combined with VT ablation for the secondary prevention of sudden cardiac death: pilot data from the prospective multinational SICD-VTAbl study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
I Goldenberg ◽  
P Maury ◽  
F Sacher ◽  
N Clementy ◽  
D T Huang ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Clinical Outcomes ◽  
Preliminary Data ◽  
Outcome Data ◽  
Icd Implantation ◽  
Systemic Complications ◽  
Subcutaneous Icd ◽  
Icd Therapy ◽  
Vt Ablation

Abstract Background The aim of the Subcutaneous ICD Combined with Ventricular Tachycardia Ablation (SICD-VTAbl) Study is to provide preliminary data on the safety and efficacy of a management strategy that incorporates S-ICD implantation and VT ablation among patients with a secondary prevention indication for an ICD. We hypothesize that VT ablation for the prevention of monomorphic VT recurrence combined with S-ICD implantation for termination of life-threatening VT/VF is safe, while reducing the need for device interventions and systemic complications associated with conventional transvenous ICD implantation for secondary prevention. Methods SICD-VTAbl is an uncontrolled, prospective, multinational observational study, conducted in France, Germany, US (Rochester NY, and Rochester MN) and coordinated in Israel. We aim to prospectively enroll 30 patients presenting with scar-related VT/VF who will undergo VT ablation/substrate modification followed by S-ICD implantation. The primary endpoint is the first occurrence of S-ICD therapy (appropriate and inappropriate). Secondary endpoints include separate occurrence of appropriate and inappropriate ICD therapies, peri-procedural complications, and adverse clinical outcomes. Results We provide clinical, arrhythmia, and outcome data on the first 15 patients enrolled in the SICD-VTAbl Study through February 2021. Mean age was 59±12 years, 78% were males, 60% had New York Heart Association (NYHA) Class ≥II symptoms, 20% had renal insufficiency, and 33% were treated with an antiarrhythmic medication (all amiodarone). Periprocedural, arrhythmia, and long-term outcome data are provided in Table 1. There were no major complications associated with the VT ablation and the S-ICD implantation procedures. During a median follow-up of 6 months (interquartile range: 2–12 months), 2 patients (13%) received S-ICD therapy: one patient (7%) experienced VF terminated by the S-ICD and one patient experienced a single episode of inappropriate S-ICD therapy. Adverse events during follow-up, unrelated to study procedures, occurred in 3 patients (20%): hospitalization for heart failure exacerbation (N=1) and non-cardiovascular hospitalizations (N=2). None of the patients died during follow-up (Table 1). Conclusions Our preliminary data from the SICD-VTAbl Study suggest that a management approach that incorporates VT ablation followed by S-ICD implantation is safe and may lead to improved arrhythmia and clinical outcomes in patients presenting with a secondary prevention indication for an ICD. FUNDunding Acknowledgement Type of funding sources: Other. Main funding source(s): Research grant to Sheba Medical Center from Boston Scientific

Secondary prevention of sudden cardiac death after catheter ablation of ventricular tachycardia

ESC CardioMed ◽  
2018 ◽  
pp. 2361-2363
Author(s):  
Arash Arya
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Secondary Prevention ◽  
Systolic Function ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Icd Implantation ◽  
Risk Patients ◽  
Resolution Mapping

The number of catheter ablation procedures for ventricular tachycardia is increasing. More patients with scar-related ventricular tachycardia have preserved left ventricular function. Implantation of an implantable cardioverter defibrillator (ICD) is currently recommended after the occurrence of sustained monomorphic ventricular tachycardia in patients with structural heart disease whether the arrhythmia is tolerated or not, even in the presence of normal or near-normal ventricular systolic function. The published data and data from the author’s group suggest that in lower-risk patients presenting with stable, monomorphic, scar-related ventricular tachycardia and a left ventricular ejection fraction greater than 35%, an alternative strategy with primary catheter ablation and deferred ICD implantation may be the preferred approach. Scar visualization using cardiovascular magnetic resonance imaging, high-resolution mapping, and better risk stratification after successful catheter ablation of ventricular tachycardia may further help to select the low-risk patients who would not need an ICD after catheter ablation for secondary prevention.

Worldwide differences in primary prevention implantable cardioverter defibrillator utilization and outcomes in hypertrophic cardiomyopathy

2021 ◽  
Author(s):  
Victor Nauffal ◽  
Peter Marstrand ◽  
Larry Han ◽  
Victoria N Parikh ◽  
Adam S Helms ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Primary Prevention ◽  
Implantable Cardioverter Defibrillator ◽  
Cox Proportional Hazards ◽  
Icd Implantation ◽  
Icd Therapy ◽  
Cardioverter Defibrillator ◽  
Significant Difference ◽  
Implantation Rates ◽  
The Impact

Abstract Aims  Risk stratification algorithms for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) and regional differences in clinical practice have evolved over time. We sought to compare primary prevention implantable cardioverter defibrillator (ICD) implantation rates and associated clinical outcomes in US vs. non-US tertiary HCM centres within the international Sarcomeric Human Cardiomyopathy Registry. Methods and results We included patients with HCM enrolled from eight US sites (n = 2650) and five non-US (n = 2660) sites and used multivariable Cox-proportional hazards models to compare outcomes between sites. Primary prevention ICD implantation rates in US sites were two-fold higher than non-US sites (hazard ratio (HR) 2.27 [1.89–2.74]), including in individuals deemed at high 5-year SCD risk (≥6%) based on the HCM risk-SCD score (HR 3.27 [1.76–6.05]). US ICD recipients also had fewer traditional SCD risk factors. Among ICD recipients, rates of appropriate ICD therapy were significantly lower in US vs. non-US sites (HR 0.52 [0.28–0.97]). No significant difference was identified in the incidence of SCD/resuscitated cardiac arrest among non-recipients of ICDs in US vs. non-US sites (HR 1.21 [0.74–1.97]). Conclusion  Primary prevention ICDs are implanted more frequently in patients with HCM in US vs. non-US sites across the spectrum of SCD risk. There was a lower rate of appropriate ICD therapy in US sites, consistent with a lower-risk population, and no significant difference in SCD in US vs. non-US patients who did not receive an ICD. Further studies are needed to understand what drives malignant arrhythmias, optimize ICD allocation, and examine the impact of different ICD utilization strategies on long-term outcomes in HCM.

Abstract 17371: In-Hospital Outcomes of Ablation for Ventricular Tachycardia in Heart Failure With Reduced Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Raj Patel ◽  
Dipesh Ludhwani ◽  
Harsh P Patel ◽  
Samarthkumar J Thakkar ◽  
Love shah ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Ejection Fraction ◽  
Reference Group ◽  
Coronary Bypass ◽  
Reference Population ◽  
Reduced Ejection Fraction ◽  
Vt Ablation

Introduction: Ventricular tachycardia (VT) is a significant cause of morbidity and mortality in patients with heart failure with reduced ejection fraction (HFrEF). Hypothesis: Data on efficacy, safety, and outcomes of catheter ablation for VT in HFrEF have not been studied well. Methods: The 2002-2014 Nationwide Inpatient Sample (NIS) was used to identify all hospitalizations with a principle diagnosis of VT (International Classification of Diseases, Ninth Edition, Clinical Modification [ICD-9-CM] code 427.1) and a secondary diagnosis of HFrEF. Patients who underwent catheter ablation were identified using ICD-9-CM procedure code 37.34. Results: Of 228,557 patients with HFrEF & VT, 5845 (2.56%) underwent catheter ablation. The prevalence of Diabetes Mellitus (DM) and Chronic Kidney disease (CKD) was higher in the reference population contrary to a higher prevalence of prior myocardial infarction (MI), coronary bypass and AICD in those undergoing CA. The frequency of complications in the ablation group was 19.47%, the most common being post-operative hemorrhage (8.3%). This was followed by myocardial infarction (5.34%), pericardial complications (3.38%), and neurological complications (2.14%) (Figure 1.). The odds of in-hospital mortality were lower in the CA group compared to the reference group (5.08% vs 9.42%, p<0.05). Conclusions: Compared to medical therapy, VT ablation in HFrEF is associated with lower mortality though with significant complication rate. This suggests a need for future studies identifying the safety measures in VT ablations and instituting appropriate interventions to improve overall VT ablation outcomes.

Abstract 11447: Low Incidence of Appropriate Therapy Following Defibrillator Implantation for Primary Prevention of Sudden Cardiac Death in Hypertrophic Cardiomyopathy

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Amalie C Thavikulwat ◽  
Todd T Tomson ◽  
Bradley P Knight ◽  
Robert O Bonow ◽  
Lubna Choudhury
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Hypertrophic Cardiomyopathy ◽  
Primary Prevention ◽  
Sudden Cardiac Death ◽  
Secondary Prevention ◽  
Cardiac Death ◽  
Icd Implantation ◽  
Icd Therapy ◽  
Appropriate Therapy

Introduction: Hypertrophic cardiomyopathy (HCM) is a leading cause of sudden cardiac death (SCD) in young adults. Implantable cardioverter defibrillators (ICD) effectively terminate ventricular tachycardia (VT) and fibrillation (VF) that cause SCD, but the reported prevalence of and patient characteristics leading to appropriate ICD therapy in HCM have been variable. Hypothesis: We hypothesized that some risk factors may be more prevalent than others in patients with HCM who receive appropriate ICD therapy and that the overall incidence of appropriate therapy may be lower than that reported previously. Methods: We retrospectively studied all patients with HCM who were treated with ICDs at our referral center from 2000-2013 to determine the rates of appropriate and inappropriate ICD therapies. Results: Of 1136 patients with HCM, we identified 135 who underwent ICD implantation (125 for primary and 10 for secondary prevention), aged 18-81 years (mean 48±17) at the time of implantation. The mean follow-up time was 5.2±4.5 years. Appropriate ICD intervention occurred in 20 of 135 patients (2.8%/year) by providing a shock or antitachycardia pacing in response to VT or VF. The annual rate of appropriate ICD therapy was 2.4%/year for primary and 7.2%/year for secondary prevention devices. Commonly used risk factors were equally prevalent among patients who received appropriate therapy and those who did not; furthermore, the likelihood of receiving appropriate therapy in the presence of each risk factor was similar (Figure). Inappropriate ICD therapy occurred in 27 patients (3.8%/year). Conclusions: ICDs provide clear benefit to patients who experience life-threatening arrhythmias, particularly those being treated for secondary prevention. However, the appropriate therapy rate for primary prevention was lower than previously reported, and no single risk factor appeared to have stronger association with appropriate ICD therapy than others.

Endo‐epicardial vs endocardial‐only catheter ablation of ventricular tachycardia: A meta‐analysis

2019 ◽  
Vol 30 (9) ◽  
pp. 1537-1548 ◽  
Author(s):  
Rhanderson Cardoso ◽  
Fabrizio R. Assis ◽  
Andre D’Avila
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Meta Analysis
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