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SAFETY AND OUTCOMES OF CATHETER ABLATION FOR TREATMENT OF REFRACTORY VENTRICULAR ARRHYTHMIAS IN PATIENTS WITH ADVANCED HEART FAILURE
535 JACC March 21, 2017 Volume 69, Issue 11
Arrhythmias and Clinical EP SAFETY AND OUTCOMES OF CATHETER ABLATION FOR TREATMENT OF REFRACTORY VENTRICULAR ARRHYTHMIAS IN PATIENTS WITH ADVANCED HEART FAILURE Poster Contributions Poster Hall, Hall C Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m. Session Title: Atrial Fibrillation and VT: Incorporating Novel Risks Toward Decision Making Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias Presentation Number: 1280-096 Authors: Michael Cowherd, Peter Rothstein, Alexis Tumolo, Natasha Altman, Prateeti Khazanie, Amrut Ambardekar, Andreas Brieke, Eugene Wolfel, William Cornwell, Matthew Zipse, Duy Nguyen, Lucas Marzec, Ryan Aleong, Christine Tompkins, Larry Allen, William Sauer, Wendy Tzou, University of Colorado Denver, Aurora, CO, USA
Background: Patients with New York Heart Association Class 4 heart failure (NYHA4) and ventricular tachycardia (VT) are often not considered for radiofrequency ablation (RFA), in part due to safety concerns. We sought to evaluate the safety and efficacy of VT RFA in NYHA4 patients. Methods: We retrospectively evaluated NYHA4 patients with VT hospitalized at a tertiary-referral medical center, for whom electrophysiology was consulted. Characteristics and outcomes were compared between those who underwent RFA vs. medical therapy only (NoRFA).
Results: Eighty patients were identified with mean age 60.4±12.0 yrs; 90% were male, 55% had ischemic cardiomyopathy, and LVEF was 22±10%. Management was RFA in 51% and NoRFA in 49%. There were no significant differences in baseline characteristics between RFA and NoRFA except that RFA patients were more likely to present with ICD storm (37% vs. 13%, p=0.02) or incessant VT (24% vs. 5%, p=0.03) and were treated with more antiarrhythmic drugs (1.9±1.3 vs 0.5±0.8, p<0.001). RFA complications included pericardial effusion in 2 (5%), 1 of which required pericardiocentesis, and TIA in 1 (2%). Freedom from VT recurrence was significantly better for RFA vs. NoRFA (73.2% vs. 33.3%, log-rank p<0.001, Figure, A); 1-year survival was similar (78% RFA vs. 69.2% NoRFA, long-rank p=0.46, Figure, B). Conclusions: RFA can be safely performed among NYHA4 patients with medically refractory VT, without increased mortality and with significantly improved freedom from recurrent VT.
Arrhythmias and Clinical EP SAFETY AND OUTCOMES OF CATHETER ABLATION FOR TREATMENT OF REFRACTORY VENTRICULAR ARRHYTHMIAS IN PATIENTS WITH ADVANCED HEART FAILURE Poster Contributions Poster Hall, Hall C Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m. Session Title: Atrial Fibrillation and VT: Incorporating Novel Risks Toward Decision Making Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias Presentation Number: 1280-096 Authors: Michael Cowherd, Peter Rothstein, Alexis Tumolo, Natasha Altman, Prateeti Khazanie, Amrut Ambardekar, Andreas Brieke, Eugene Wolfel, William Cornwell, Matthew Zipse, Duy Nguyen, Lucas Marzec, Ryan Aleong, Christine Tompkins, Larry Allen, William Sauer, Wendy Tzou, University of Colorado Denver, Aurora, CO, USA
Background: Patients with New York Heart Association Class 4 heart failure (NYHA4) and ventricular tachycardia (VT) are often not considered for radiofrequency ablation (RFA), in part due to safety concerns. We sought to evaluate the safety and efficacy of VT RFA in NYHA4 patients. Methods: We retrospectively evaluated NYHA4 patients with VT hospitalized at a tertiary-referral medical center, for whom electrophysiology was consulted. Characteristics and outcomes were compared between those who underwent RFA vs. medical therapy only (NoRFA).
Results: Eighty patients were identified with mean age 60.4±12.0 yrs; 90% were male, 55% had ischemic cardiomyopathy, and LVEF was 22±10%. Management was RFA in 51% and NoRFA in 49%. There were no significant differences in baseline characteristics between RFA and NoRFA except that RFA patients were more likely to present with ICD storm (37% vs. 13%, p=0.02) or incessant VT (24% vs. 5%, p=0.03) and were treated with more antiarrhythmic drugs (1.9±1.3 vs 0.5±0.8, p<0.001). RFA complications included pericardial effusion in 2 (5%), 1 of which required pericardiocentesis, and TIA in 1 (2%). Freedom from VT recurrence was significantly better for RFA vs. NoRFA (73.2% vs. 33.3%, log-rank p<0.001, Figure, A); 1-year survival was similar (78% RFA vs. 69.2% NoRFA, long-rank p=0.46, Figure, B). Conclusions: RFA can be safely performed among NYHA4 patients with medically refractory VT, without increased mortality and with significantly improved freedom from recurrent VT.