Ten-year outcomes and predictors of mortality following catheter ablation of ventricular tachycardia

https://doi.org/10.1007/s00392-024-02526-y

Laura Rottner (Hamburg)1, A. Metzner (Hamburg)2, M. Hochadel (Ludwigshafen am Rhein)3, J. Senges (Ludwigshafen am Rhein)4, S. Willems (Hamburg)5, H. Ince (Berlin)6, L. Eckardt (Münster)7, T. Deneke (Nürnberg)8, P. Lugenbiel (Heidelberg)9, J. Brachmann (Coburg)10, K. R. J. Chun (Frankfurt am Main)11, R. R. Tilz (Lübeck)12, A. Rillig (Hamburg)2

1Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie Hamburg, Deutschland; 2Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie Hamburg, Deutschland; 3IHF GmbH Statistik Ludwigshafen am Rhein, Deutschland; 4Stiftung Institut für Herzinfarktforschung Ludwigshafen am Rhein, Deutschland; 5Asklepios Klinik St. Georg Kardiologie & internistische Intensivmedizin Hamburg, Deutschland; 6Vivantes Klinikum Am Urban Klinik für Innere Medizin, Kardiologie und konservative Intensivmedizin Berlin, Deutschland; 7Universitätsklinikum Münster Klinik für Kardiologie II - Rhythmologie Münster, Deutschland; 8Klinikum Nürnberg Süd Kardiologie Nürnberg, Deutschland; 9Universitätsklinikum Heidelberg Klinik für Innere Med. III, Kardiologie, Angiologie u. Pneumologie Heidelberg, Deutschland; 10Medical School / Regiomed GmbH Coburg, Deutschland; 11Agaplesion Markus Krankenhaus Medizinische Klinik III - CCB Frankfurt am Main, Deutschland; 12Universitätsklinikum Schleswig-Holstein Klinik für Rhythmologie Lübeck, Deutschland

 

Background: Catheter ablation is the primary treatment option for idiopathic ventricular tachycardia (VT), plays a key role in acute therapy of electrical storm and treatment of VTs in patients with structural heart disease (SHD), and can reduce VT-burden. However, data on long-term outcome following VT-ablation, is lacking.

Aim: We report on 10-year clinical outcomes following VT-ablation from patients enrolled in the prospective German Ablation Registry. 

Methods: Long-term follow-up was conducted on 334 patients undergoing VT-ablation (118/334 (35%) with structural normal hearts (SNH) and 216/334 (65%) with SHD; 161/216 (75%) with ischemic heart disease (IHD)) at 38 centers.

Results: Follow-up was completed in 94.8% of patients. Median follow-up duration was 10.8 (4.3; 12.3) years, with a mortality rate of 37.8%. VT-ablation in patients with SHD was associated with worse long-term outcome when compared to patients with SNH (estimated 10-year mortality for SHD 53.4% vs. SNH 12.1%). Estimated 10-year mortality following VT ablation was highest in patients with IHD (60.5%). Predictors of long-term mortality following VT-ablation included age (hazard ratio [HR] 2.31 [1.87-2.86] per decade), LVEF ≤ 30% (HR 2.23 [1.53-3.24]), diabetes (HR 1.56 [1.01-2.41]), incessant VT (HR 2.13 [1.23-3.67]), linear lesion (HR 1.77 [1.20-2.63]), and acute procedural failure (HR 2.04 [1.08-3.86]). Procedural failure was the only independent predictor for VT-recurrence during 10-years follow-up (HR 3.76 [1.59-8.91]).

Conclusion: VT-ablation results in satisfying 10-year clinical outcome. All-cause mortality after VT-ablation is worse in patients with SHD when compared to patients with SNH, and highest for patients with IHD. Acute procedural success plays a major role VT-recurrence and long-term mortality.


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