Catheter ablation of ventricular arrhythmias and in-hospital mortality: insights from the German-wide Helios hospital network of 5052 cases.

Autor:	König S; Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig, Germany.; Leipzig Heart Institute, Leipzig, Germany., Ueberham L; Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig, Germany.; Leipzig Heart Institute, Leipzig, Germany., Müller-Röthing R; Leipzig Heart Institute, Leipzig, Germany., Wiedemann M; Department of Cardiology, Helios Hospital Berlin-Buch, Berlin, Germany., Ulbrich M; Department of Internal Medicine I, Helios Hospital München West, München, Germany., Sause A; Department of Cardiology, Helios University Hospital Wuppertal, Wuppertal, Germany., Tebbenjohanns J; Department of Cardiology, Helios Hospital Hildesheim, Hildesheim, Germany., Schade A; Department of Cardiology, Helios Hospital Erfurt, Erfurt, Germany., Shin DI; Department of Cardiology, Helios Hospital Krefeld, Krefeld, Germany., Staudt A; Department of Cardiology and Angiology, Helios Hospital Schwerin, Schwerin, Germany., Andrié R; Department of Cardiology, Helios Hospital Siegburg, Siegburg, Germany., Neuser H; Department of Internal Medicine II, Helios Hospital Plauen, Plauen, Germany., Kuhlen R; Helios Health, Berlin, Germany., Arya A; Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig, Germany., Hindricks G; Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig, Germany.; Leipzig Heart Institute, Leipzig, Germany., Bollmann A; Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig, Germany.; Leipzig Heart Institute, Leipzig, Germany.
Jazyk:	angličtina
Zdroj:	Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology [Europace] 2020 Jan 01; Vol. 22 (1), pp. 100-108.
DOI:	10.1093/europace/euz260
Abstrakt:	Aims: Catheter ablation (CA) of ventricular arrhythmias is one of the most challenging electrophysiological interventions with an increasing use over the last years. Several benefits must be weighed against the risk of potentially life-threatening complications which necessitates a steady reevaluation of safety endpoints. Therefore, the aims of this study were (i) to investigate overall in-hospital mortality in patients undergoing such procedures and (ii) to identify variables associated with in-hospital mortality in a German-wide hospital network. Methods and Results: Between January 2010 and September 2018, administrative data provided by 85 Helios hospitals were screened for patients with main or secondary discharge diagnosis of ventricular tachycardia (VT) or premature ventricular contractions (PVCs) in combination with an arrhythmia-related CA using ICD- and OPS codes. In 5052 cases (mean age 60.9 ± 14.3 years, 30.1% female) of 30 different hospitals, in-hospital mortality was 1.27% with a higher mortality in patients ablated for VT (1.99%, n = 2, 955) compared to PVC (0.24%, n = 2, 097, P < 0.01). Mortality rates were 2.06% in patients with ischaemic heart disease (IHD, n = 2, 137), 1.47% in patients with non-ischaemic structural heart disease (NIHD, n = 1, 224), and 0.12% in patients without structural heart disease (NSHD, n = 1, 691). Considering different types of hospital admission, mortality rates were 0.35% after elective (n = 2, 825), 1.60% after emergency admission/hospital transfer <24 h (n = 1, 314) and 3.72% following delayed hospital transfer >24 h after initial admission (n = 861, P < 0.01 vs. elective admission and emergency admission/hospital transfer <24 h). In multivariable analysis, a delayed hospital transfer >24 h [odds ratio (OR) 2.28, 95% confidence interval (CI) 1.59-3.28, P < 0.01], the occurrence of procedure-related major adverse events (OR 6.81, 95% CI 2.90-16.0, P < 0.01), Charlson Comorbidity Index (CCI, OR 2.39, 95% CI 1.56-3.66, P < 0.01) and its components congestive heart failure (OR 8.04, 95% CI 1.71-37.8, P < 0.01), and diabetes mellitus (OR 1.59, 95% CI 1.13-2.22, P < 0.01) were significantly associated with in-hospital death. Conclusions: We reported in-hospital mortality rates after CA of ventricular arrhythmias in the largest multicentre, administrative dataset in Germany which can be implemented in quality management programs. Aside from comorbidities, a delayed hospital transfer to a CA performing centre is associated with an increased in-hospital mortality. This deserves further studies to determine the optimal management strategy. (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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