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BIBTEX RIS

Outcomes of a combined vs non-combined endo-epicardial ventricular tachycardia ablation strategy

2022; Springer Science+Business Media; Volume: 66; Issue: 1 Linguagem: Inglês

10.1007/s10840-022-01175-3

ISSN

1572-8595

Autores

Daniel Matos, Pedro Adragão, Cristiano Pisani, Vinicius Hatanaka, P Freitas, Francisco Moscoso Costa, Muhiedinne Chokr, Carina Hardy, A Ferreira, Pedro Carmo, Sissy Laura, F Morgado, Diogo Cavaco, Miguel Mendes, Maurício Scanavacca,

Tópico(s)

Cardiac electrophysiology and arrhythmias

Resumo

Direct comparisons of combined (C-ABL) and non-combined (NC-ABL) endo-epicardial ventricular tachycardia (VT) ablation outcomes are scarce. We aimed to investigate the long-term clinical efficacy and safety of these 2 strategies in ischemic heart disease (IHD) and non-ischemic cardiomyopathy (NICM) populations.Multicentric observational registry included 316 consecutive patients who underwent catheter ablation for drug-resistant VT between January 2008 and July 2019. Primary and secondary efficacy endpoints were defined as VT-free survival and all-cause death after ablation. Safety outcomes were defined by 30-day mortality and procedure-related complications.Most of the patients were male (85%), with IHD (67%) and mean age of 63 ± 13 years. During a mean follow-up of 3 ± 2 years, 117 (37%) patients had VT recurrence and 73 (23%) died. Multivariate survival analysis identified electrical storm (ES) at presentation, IHD, left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) functional class III / IV, and C-ABL as independent predictors of VT recurrence. In 135 patients undergoing repeated procedures, only C-ABL and ES were independent predictors of relapse. The identified independent predictors of mortality were C-ABL, ES, LVEF, age, and NYHA class III / IV. C-ABL survival benefit was only seen in patients with a previous ablation (P for interaction = 0.04). Mortality at 30 days was similar between NC-ABL and C-ABL (4% vs. 2%, respectively, P = 0.777), as was complication rate (10.3% vs. 15.1%, respectively, P = 0.336).A combined or sequential endo-epicardial VT ablation strategy was associated with lower VT recurrence and lower all-cause death in IHD and NICM patients undergoing repeated procedures. Both approaches seemed equally safe.

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