Ten years after catheter ablation of idiopathic ventricular tachycardia, mortality approaches 40% for all-comers, the rate being higher for those with structural heart disease, more favorable for those with normal heart structure, according to a German study published in the Journal of the American Heart Association (JAHA).
Catheter ablation is the primary treatment option for idiopathic ventricular tachycardia. Previous studies of its results have limited follow-up duration, with most not exceeding two years. Few long-term data are available on mortality and recurrence of ventricular tachycardia after ablation, point out Laura Rottner of the University Hospital of Hamburg (Germany) and her colleagues.
From the German ablation registry, in which 55 electrophysiology centers participate, including 38 centers specializing in the ablation of ventricular tachycardia, they analyzed the 10-year follow-up data of 334 patients who received this intervention by catheter. Among them, 118 (35%) had normal heart structure and 216 (65%) had structural heart disease, including 161 (75%) with ischemic heart disease. Complete follow-up data were available for 94.8% of patients.
The 10-year all-cause mortality rate was 39.4%. It was 54.8% for patients with structural heart disease, compared to 12.1% for patients with normal heart structure, a statistically significant difference. Among patients with structural heart disease, those with ischemic heart disease had an even higher 10-year mortality rate, 62.4%, compared to 33.6% among those without ischemic disease, the difference being statistically significant.
Furthermore, re-hospitalizations were significantly more frequent for patients with structural heart disease than for those with normal heart structure (71.4% versus 27.3%), particularly re-hospitalizations for recurrence of ventricular tachycardia. (41.9% versus 16.3%), but there was no difference between those with ischemic disease and those without.
-Significant predictors of mortality after ventricular tachycardia ablation were age, left ventricular ejection fraction less than or equal to 30%, diabetes, incessant ventricular tachycardia, linear lesion, and acute procedural failure. Procedural failure was the only factor significantly predictive of ventricular tachycardia recurrence.
This is the first study of 10-year all-cause mortality and predictors of outcome after catheter ablation of ventricular tachycardia in patients with structural heart disease and those with normal heart structure, conducted from of a large prospective multicenter registry of ablations, comment the authors. This study “provides new evidence in the field of ventricular tachycardia ablation and for appropriate patient selection”, they conclude.
(JAHA, online publication December 24, 2024)
