Arrhythmia exacerbation after post-infarction ventricular tachycardia ablation: prevalence and prognostic significance.

Abstract

AIMS:

Catheter ablation is an effective treatment for post-infarction ventricular tachycardia (VT). However, some patients may experience a worsened arrhythmia phenotype after ablation. We aimed to determine the prevalence and prognostic impact of arrhythmia exacerbation (AE) after post-infarction VT ablation.

METHODS AND RESULTS:

A total of 1187 consecutive patients (93% men, median age 68 years, median ejection fraction 30%) who underwent post-infarction VT ablation at six centres were included. Arrhythmia exacerbation was defined as post-ablation VT storm or incessant VT in patients without prior similar events. During follow-up (median 717 days), 426 (36%) patients experienced VT recurrence. Events qualifying as AE occurred in 67 patients (6%). Median times to VT recurrence with and without AE were 238 [interquartile range (IQR) 35-640] days and 135 (IQR 22-521) days, respectively (P = 0.25). Almost half of the patients (46%) who experienced AE experienced it within 6 months of the index procedure. Patients with AE had had longer ablation times during the ablation procedures compared to the rest of the patients (median 42 vs. 34 min, P = 0.02). Among patients with VT recurrence, the risk of death or heart transplantation was significantly higher in patients with than without AE (hazard ratio 1.99, 95% CI 1.28-3.10; P = 0.002) after adjusting for age, gender, ejection fraction, cardiac resynchronization therapy, post-ablation non-inducibility, and post-ablation amiodarone use.

CONCLUSION:

Arrhythmia exacerbation after ablation of infarct-related VT is infrequent but is independently associated with an adverse long-term outcome among patients who experience a VT recurrence. The mechanisms and mitigation strategies of AE after catheter ablation require further investigation.

• Authors: Konstantinos C Siontis, Hyungjin M Kim, Pasquale Vergara, Giovanni Peretto, Duc H Do, Marta de Riva, Anna Lam, Pierre Qian, Miki Yokokawa, Krit Jongnarangsin, Rakesh Latchamsetty, Pierre Jais, Fred Sacher, Usha Tedrow, Kalyanam Shivkumar, Katja Zeppenfeld, Paolo Della Bella, William G Stevenson, Fred Morady, Frank M Bogun
• Journal: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology (Europace) Vol. 22 Issue 11 Pg. 1680-1687 (11 01 2020) ISSN: 1532-2092 [Electronic] England
• PMID: 32830247 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: [email protected].

Topics

• Aged
• Catheter Ablation (adverse effects)
• Female
• Humans
• Infarction
• Male
• Prevalence
• Prognosis
• Recurrence
• Tachycardia, Ventricular (diagnosis, epidemiology, etiology)
• Treatment Outcome