Outcomes of ventricular tachycardia ablation in patients with structural heart disease: The impact of electrical storm.
AIMS:To investigate predictors of long-term outcomes after catheter ablation (CA) for ventricular tachycardia (VT) and the impact of electrical storm (ES) prior to index ablation procedures. METHODS:We studied consecutive patients with structural heart disease and VT (n = 328; age: 63±12 years; 88%...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2017-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC5302378?pdf=render |
| _version_ | 1819076458128080896 |
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| author | Bashar Aldhoon Dan Wichterle Petr Peichl Robert Čihák Josef Kautzner |
| author_facet | Bashar Aldhoon Dan Wichterle Petr Peichl Robert Čihák Josef Kautzner |
| author_sort | Bashar Aldhoon |
| collection | DOAJ |
| description | AIMS:To investigate predictors of long-term outcomes after catheter ablation (CA) for ventricular tachycardia (VT) and the impact of electrical storm (ES) prior to index ablation procedures. METHODS:We studied consecutive patients with structural heart disease and VT (n = 328; age: 63±12 years; 88% males; 72% ischaemic cardiomyopathy; LVEF: 32±12%) who had undergone CA. According to presenting arrhythmia at baseline, they were divided into ES (n = 93, 28%) and non-ES groups. Clinical predictors of all-cause mortality were investigated and a clinically useful risk score (SCORE) was constructed. RESULTS:During a median follow-up of 927 days (IQR: 564-1626), 67% vs. 60% of patients (p = 0.05) experienced VT recurrence in the ES vs. the non-ES group, respectively; and 41% vs. 32% patients died (p = 0.02), respectively. Five factors were independently associated with mortality: age >70 years (hazard ratio (HR): 1.6, 95% confidence interval (CI): 1.1-2.4, p = 0.01), NYHA class ≥3 (HR: 1.9, 95% CI: 1.2-2.9, p = 0.005), a serum creatinine level >1.3 mg/dL (HR: 1.6, 95% CI: 1.1-2.3, p = 0.02), LVEF ≤25% (HR: 2.4, 95% CI: 1.6-3.5, p = 0.00004), and amiodarone therapy (HR: 1.5, 95% CI: 1.0-2.2, p = 0.03). A risk SCORE ranging from 0-4 (1 point for either high-risk age, NYHA, creatinine, or LVEF) correlated with mortality. ES during index ablation independently predicted mortality only in patients with a SCORE ≤1. CONCLUSIONS:Advanced LV dysfunction, older age, higher NYHA class, renal dysfunction, and amiodarone therapy, but not ES, were predictors of poor outcomes after CA for VT in the total population. However, ES did predict mortality in a low-risk sub-group of patients. |
| first_indexed | 2024-12-21T18:41:37Z |
| format | Article |
| id | doaj.art-0a1293ccb3264a58972524184a9774a9 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-21T18:41:37Z |
| publishDate | 2017-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-0a1293ccb3264a58972524184a9774a92022-12-21T18:53:59ZengPublic Library of Science (PLoS)PLoS ONE1932-62032017-01-01122e017183010.1371/journal.pone.0171830Outcomes of ventricular tachycardia ablation in patients with structural heart disease: The impact of electrical storm.Bashar AldhoonDan WichterlePetr PeichlRobert ČihákJosef KautznerAIMS:To investigate predictors of long-term outcomes after catheter ablation (CA) for ventricular tachycardia (VT) and the impact of electrical storm (ES) prior to index ablation procedures. METHODS:We studied consecutive patients with structural heart disease and VT (n = 328; age: 63±12 years; 88% males; 72% ischaemic cardiomyopathy; LVEF: 32±12%) who had undergone CA. According to presenting arrhythmia at baseline, they were divided into ES (n = 93, 28%) and non-ES groups. Clinical predictors of all-cause mortality were investigated and a clinically useful risk score (SCORE) was constructed. RESULTS:During a median follow-up of 927 days (IQR: 564-1626), 67% vs. 60% of patients (p = 0.05) experienced VT recurrence in the ES vs. the non-ES group, respectively; and 41% vs. 32% patients died (p = 0.02), respectively. Five factors were independently associated with mortality: age >70 years (hazard ratio (HR): 1.6, 95% confidence interval (CI): 1.1-2.4, p = 0.01), NYHA class ≥3 (HR: 1.9, 95% CI: 1.2-2.9, p = 0.005), a serum creatinine level >1.3 mg/dL (HR: 1.6, 95% CI: 1.1-2.3, p = 0.02), LVEF ≤25% (HR: 2.4, 95% CI: 1.6-3.5, p = 0.00004), and amiodarone therapy (HR: 1.5, 95% CI: 1.0-2.2, p = 0.03). A risk SCORE ranging from 0-4 (1 point for either high-risk age, NYHA, creatinine, or LVEF) correlated with mortality. ES during index ablation independently predicted mortality only in patients with a SCORE ≤1. CONCLUSIONS:Advanced LV dysfunction, older age, higher NYHA class, renal dysfunction, and amiodarone therapy, but not ES, were predictors of poor outcomes after CA for VT in the total population. However, ES did predict mortality in a low-risk sub-group of patients.http://europepmc.org/articles/PMC5302378?pdf=render |
| spellingShingle | Bashar Aldhoon Dan Wichterle Petr Peichl Robert Čihák Josef Kautzner Outcomes of ventricular tachycardia ablation in patients with structural heart disease: The impact of electrical storm. PLoS ONE |
| title | Outcomes of ventricular tachycardia ablation in patients with structural heart disease: The impact of electrical storm. |
| title_full | Outcomes of ventricular tachycardia ablation in patients with structural heart disease: The impact of electrical storm. |
| title_fullStr | Outcomes of ventricular tachycardia ablation in patients with structural heart disease: The impact of electrical storm. |
| title_full_unstemmed | Outcomes of ventricular tachycardia ablation in patients with structural heart disease: The impact of electrical storm. |
| title_short | Outcomes of ventricular tachycardia ablation in patients with structural heart disease: The impact of electrical storm. |
| title_sort | outcomes of ventricular tachycardia ablation in patients with structural heart disease the impact of electrical storm |
| url | http://europepmc.org/articles/PMC5302378?pdf=render |
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