Mortality after catheter ablation of structural heart disease related ventricular tachycardia.

Background: There is a paucity of data describing mortality after catheter ablation of ventricular tachycardia (VT).
Objectives: We describe the causes and predictors of cardiac transplant and/or mortality following catheter ablation of structural heart disease (SHD) related VT.
Methods: Over 10-years, 175 SHD patients underwent VT ablation. Clinical characteristics, and outcomes, were compared between patients undergoing transplant and/or dying and those surviving.
Results: During 2.8 (IQR 1.9-5.0) years follow-up, 37/175 (21%) patients underwent transplant and/or died following VT ablation. Prior to ablation, these patients were older (70.3 ± 11.1 vs. 62.1 ± 13.9 years, P = 0.001), had lower left ventricular ejection fraction ([LVEF] 30 ± 12% vs. 44 ± 14%, P < 0.001), and were more likely to have failed amiodarone (57% vs. 39%, P = 0.050), compared to those that survived. Predictors of transplant and/or mortality included LVEF≤35% (HR 4.71 [95% CI 2.18-10.18], P < 0.001), age ≥ 65 years (HR 2.18 [95% CI 1.01-4.73], P = 0.047), renal impairment (HR 3.73 [95% CI 1.80-7.74], P < 0.001), amiodarone failure (HR 2.67 [95% CI 1.27-5.63], P = 0.010) and malignancy (HR 3.09 [95% CI 1.03-9.26], P = 0.043). Ventricular arrhythmia free survival at 6-months was lower in the transplant and/or deceased, compared to non-deceased group (62% vs. 78%, P = 0.010), but was not independently associated with transplant and/or mortality. The risk score, MORTALITIES-VA, accurately predicted transplant and/or mortality (AUC: 0.872 [95% CI 0.810-0.934]).
Conclusions: Cardiac transplant and/or mortality after VT ablation occurred in 21% of patients. Independent predictors included LVEF≤35%, age ≥ 65 years, renal impairment, malignancy, and amiodarone failure. The MORTALITIES-VA score may identify patients at high-risk of transplant and/or dying after VT ablation.
Competing Interests: Declaration of Competing Interest Dr. Saurabh Kumar is supported by the NSW early-mid Career Fellowship. Dr. Kumar has received research grants from Abbott Medical and Biotronik; he has received honoraria from Biosense Webster, Abbott Medical, Biotronik, and Sanofi Aventis. Mr. Timothy Campbell has received speakers' honoraria for Biosense Webster, Inc. in the last 12 months. Dr. Yasuhito Kotake is the recipient of Nihon Koden/Abbott arrhythmia Fellowship from the Japan Heart Rhythm Society. All other authors have reported no other relationships relevant to the contents of this paper to disclose.
(Crown Copyright © 2023. Published by Elsevier B.V. All rights reserved.)