Management of Ventricular Tachycardia in the Setting of a Dedicated Unit for the Treatment of Complex Ventricular Arrhythmias: Long Term Outcome after Ablation
Background—We investigated the impact of catheter ablation on ventricular tachycardia (VT) recurrences and survival in a large number of patients with structural heart disease treated in the setting of a dedicated multi-skilled unit.
Methods and Results—Since January 2007, we have implemented a multidisciplinary model, aiming for a comprehensive management of VT patients. Programmed Ventricular Stimulation (PVS) was used to assess acute outcome. Primary end-points were VT recurrence and the occurrence of cardiac and sudden cardiac death. Overall, 528 patients were treated by ablation (634 procedures, range 1-4); Among 482 tested with PVS after the last procedure, a Class A result (non-inducibility of any VT) was obtained in 371 pts (77%), class B (inducibility of non-documented VT) in 12.4% and class C (inducibility of index VT) in 10.6%. After a median follow-up time of 26 months VT recurred in 164 among 472 (34.1%) patients. VT recurrence was documented in 28.6% of patients with Class A result vs. 39.6% of patients with Class B and 66.7% with Class C result (log-rank p<0.001). The incidence of cardiac mortality was lower in Class A patients compared to those with Class B and Class C (8.4% vs. 18.5% vs. 22%, respectively, log-rank p=0.002). Based on multivariate analysis post-procedural inducibility of index VT was independently associated both with VT recurrence (HR=4.030, p<0.001) and cardiac mortality (HR=2.099, p=0.04).
Conclusions—Within a dedicated VT unit, catheter ablation prevents long-term VT recurrences which may favourably affect survival in a large number of patients suffering from VT.
- Received December 27, 2012.
- Revision received January 30, 2013.
- Accepted February 1, 2013.
- Copyright © 2013, Circulation