Acute Failure of Catheter Ablation for Ventricular Tachycardia Due to Structural Heart Disease: Causes and Significance
Open Access
- 20 May 2013
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American Heart Association
- Vol. 2 (3), e000072
- https://doi.org/10.1161/jaha.113.000072
Abstract
Acute end points of catheter ablation for ventricular tachycardia ( VT ) remain incompletely defined. The aim of this study is to identify causes for failure in patients with structural heart disease and to assess the relation of this acute outcome to longer‐term management and outcomes. From 2002 to 2010, 518 consecutive patients (84% male, 62±14 years) with structural heart disease underwent a first ablation procedure for sustained VT at our institution. Acute ablation failure was defined as persistent inducibility of a clinical VT . Acute ablation failure was seen in 52 (10%) patients. Causes for failure were: intramural free wall VT in 13 (25%), deep septal VT in 9 (17%), decision not to ablate due to proximity to the bundle of His, left phrenic nerve, or a coronary artery in 3 (6%), and endocardial ablation failure with inability or decision not to attempt to access the epicardium in 27 (52%) patients. In multivariable analysis, ablation failure was an independent predictor of mortality (hazard ratio 2.010, 95% CI 1.147 to 3.239, P =0.004) and VT recurrence (hazard ratio 2.385, 95% CI 1.642 to 3.466, P <0.001). With endocardial or epicardial ablation, or both, acute ablation failure was seen in 10% of patients, largely due to anatomic factors. Persistence of a clinical VT is associated with recurrence and comparatively higher mortality.Keywords
This publication has 28 references indexed in Scilit:
- Catheter Ablation of Ventricular Tachycardia in Nonischemic Heart DiseaseCirculation: Arrhythmia and Electrophysiology, 2012
- Incidence and predictors of mortality following ablation of ventricular tachycardia in patients with an implantable cardioverter-defibrillatorHeart Rhythm, 2010
- Catheter Ablation of Recurrent Scar‐Related Ventricular Tachycardia Using Electroanatomical Mapping and Irrigated Ablation Technology: Results of the Prospective Multicenter Euro‐VT‐StudyJournal of Cardiovascular Electrophysiology, 2009
- EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: Developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA)Heart Rhythm, 2009
- Catheter Ablation for Scar-related Ventricular TachycardiasCurrent Problems in Cardiology, 2009
- Irrigated Radiofrequency Catheter Ablation Guided by Electroanatomic Mapping for Recurrent Ventricular Tachycardia After Myocardial InfarctionCirculation, 2008
- Prognostic Importance of Defibrillator Shocks in Patients with Heart FailureThe New England Journal of Medicine, 2008
- Quality of Life with Defibrillator Therapy or Amiodarone in Heart FailureThe New England Journal of Medicine, 2008
- Catheter Ablation for the Treatment of Electrical Storm in Patients With Implantable Cardioverter-DefibrillatorsCirculation, 2008
- Linear Ablation Lesions for Control of Unmappable Ventricular Tachycardia in Patients With Ischemic and Nonischemic CardiomyopathyCirculation, 2000