Trends and Outcomes of Catheter Ablation for Ventricular Tachycardia in a Community Cohort.

Autor:	Yousuf OK; Department of Cardiology, Johns Hopkins University, School of Medicine, Baltimore, Maryland; U.S. Food and Drug Administration, Center for Devices and Radiological Health, Silver Spring, Maryland; Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri. Electronic address: OYousuf@saint-lukes.org., Zusterzeel R; U.S. Food and Drug Administration, Center for Devices and Radiological Health, Silver Spring, Maryland., Sanders W; U.S. Food and Drug Administration, Center for Devices and Radiological Health, Silver Spring, Maryland., Caños D; U.S. Food and Drug Administration, Center for Devices and Radiological Health, Silver Spring, Maryland., Dekmezian C; Acumen, LLC, Burlingame, California., Silverman H; Acumen, LLC, Burlingame, California., Calkins H; Department of Medicine, Division of Cardiology, Johns Hopkins University, School of Medicine, Baltimore, Maryland., Berger R; Department of Medicine, Division of Cardiology, Johns Hopkins University, School of Medicine, Baltimore, Maryland., Tandri H; Department of Medicine, Division of Cardiology, Johns Hopkins University, School of Medicine, Baltimore, Maryland., Nazarian S; Department of Medicine, Division of Cardiology, Johns Hopkins University, School of Medicine, Baltimore, Maryland; University of Pennsylvania, School of Medicine, Philadelphia, Pennsylvania., Strauss DG; U.S. Food and Drug Administration, Center for Devices and Radiological Health, Silver Spring, Maryland.
Jazyk:	angličtina
Zdroj:	JACC. Clinical electrophysiology [JACC Clin Electrophysiol] 2018 Sep; Vol. 4 (9), pp. 1189-1199. Date of Electronic Publication: 2018 Aug 29.
DOI:	10.1016/j.jacep.2018.06.020
Abstrakt:	Objectives: This study examined the trend in growth of catheter ablation for ventricular tachycardia (VT) performed in the United States with analysis of rates and predictors of major adverse events. Background: Sustained VT is a significant cause of sudden death, heart failure (HF), and recurrent shocks in implantable cardioverter-defibrillator (ICD) recipients. Catheter ablation for VT reduces arrhythmia recurrence. Limited data are available regarding the use, safety, and long-term outcomes after VT ablation. Methods: Using the U.S. Medicare database linked to the Social Security Death Index, we examined the annual use of VT ablation in 21,073 patients over 12 years, with 30-day risk of mortality, nonfatal major adverse events (MAEs), 1-year risk of mortality, re-hospitalization, repeat ablation, and factors associated with adverse outcomes. Results: Among 21,073 patients (age 70 ± 9 years; 77% men; 90% white), there were 1,581 (7.5%) non-fatal MAEs within 30 days. There were 963 (4.6%) vascular complications, 485 (2.3%) pericardial complications, and 201 (1%) strokes and/or transient ischemic attacks. Mechanical circulatory support use was infrequent (2.3%). The 30-day and 1-year mortality rates were 4.2% and 15.0%, respectively. The 1-year incidence of repeat ablation was 10.2 per 100 person-years and re-hospitalization for HF or VT was 15.4 per 100 person-years and 18 per 100 person-years, respectively. Patients with an ICD had increased 30-day (4.9% vs. 0.86%) and 1-year mortality (17.5% vs. 2.54% [22.9 per 100 person-years vs. 3.1 per 100 person-years]; hazard ratio [HR]: 2.93; 95% confidence interval [CI]: 2.21 to 3.88). Rates of hospitalization for HF (18 per 100 person-years vs. 1.8 per 100 person-years; HR: 4.00; 95% CI: 2.78 to 5.78) or VT recurrence (22.7 per 100 person-years vs. 2.1 per 100 person-years; HR: 5.70; 95% CI: 4.09 to 7.96) were also higher at 1 year. Between 2000 and 2012, annual VT ablation volumes increased >4-fold. Conclusions: Catheter ablation for VT is frequently performed. Short-term MAEs and 1-year mortality is significant and is highest in patients with an ICD. These findings may provide greater insight of outcomes in an unselected real-world population undergoing VT ablation. (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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