Acute hemodynamic decompensation during catheter ablation of scar-related ventricular tachycardia: Incidence, predictors, and impact on mortality

Pasquale Santangeli, Daniele Muser, Erica S. Zado, Silvia Magnani, Sumun Khetpal, Mathew D. Hutchinson, Gregory Supple, David S. Frankel, Fermin C. Garcia, Rupa Bala, Michael P. Riley, David Lin, J. Eduardo Rame, Robert Schaller, Sanjay Dixit, Francis E. Marchlinski, David J. Callans

Research output: Contribution to journalArticlepeer-review

77 Scopus citations

Abstract

Background - The occurrence of periprocedural acute hemodynamic decompensation (AHD) in patients undergoing radiofrequency catheter ablation of scar-related ventricular tachycardia (VT) has not been previously investigated. Methods and Results - We identified univariate predictors of periprocedural AHD in 193 consecutive patients undergoing radiofrequency catheter ablation of scar-related VT. AHD was defined as persistent hypotension despite vasopressors and requiring mechanical support or procedure discontinuation. AHD occurred in 22 (11%) patients. Compared with the rest of the population, patients with AHD were older (68.5±10.7 versus 61.6±15.0 years; P=0.037); had a higher prevalence of diabetes mellitus (36% versus 18%; P=0.045), ischemic cardiomyopathy (86% versus 52%; P=0.002), chronic obstructive pulmonary disease (41% versus 13%; P=0.001), and VT storm (77% versus 43%; P=0.002); had more severe heart failure (New York Heart Association class III/IV: 55% versus 15%, P<0.001; left ventricular ejection fraction: 26±10% versus 36±16%, P=0.003); and more often received periprocedural general anesthesia (59% versus 29%; P=0.004). At 21±7 months follow-up, the mortality rate was higher in the AHD group compared with the rest of the population (50% versus 11%, log-rank P<0.001). Conclusions - AHD occurs in 11% of patients undergoing radiofrequency catheter ablation of scar-related VT and is associated with increased risk of mortality over follow-up. AHD may be predicted by clinical factors, including advanced age, ischemic cardiomyopathy, more severe heart failure status (New York Heart Association class III/IV, lower ejection fraction), associated comorbidities (diabetes mellitus and chronic obstructive pulmonary disease), presentation with VT storm, and use of general anesthesia.

Original languageEnglish (US)
Pages (from-to)68-75
Number of pages8
JournalCirculation: Arrhythmia and Electrophysiology
Volume8
Issue number1
DOIs
StatePublished - Feb 28 2015
Externally publishedYes

Keywords

  • catheter ablation
  • mortality
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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