Real-world characteristics and readmissions among patients undergoing ablation for ventricular tachycardia: a retrospective database analysis of commercially insured patients in the USA (original) (raw)
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Circulation. Arrhythmia and electrophysiology, 2015
V entricular tachycardia (VT) ablation is now performed throughout the United States in both community and tertiary medical centers, and use of this procedure has increased during the past decade. 1,2 Previous studies suggest that patients without structural heart disease experience greater procedural success and fewer periprocedural complications, 3-14 but little more is known about the factors that predispose patients to complications. Although a recent observational study assessed the incidence of complications in patients with postinfarct VT ablation, 1 the vast majority of literature addressing complications of VT ablation come from randomized trials or high-volume single-center retrospective studies. 3-16 With their small sample sizes and relatively low absolute numbers of adverse events (AEs), these publications preclude conclusions about clinical and institutional characteristics associated with periprocedural AEs or changes in event rates over time. Using publicly available hospital discharge data from multiple states in the United States, we assessed the frequency with which in-hospital AEs occurred in association with VT ablation. We sought to characterize patient-and systems-level characteristics associated with in-hospital adverse outcomes and trends in patient characteristics and outcomes over time. Methods The deidentified hospital discharge data were obtained from
Journal of the American Heart Association, 2018
Ventricular tachycardia (VT) causes significant morbidity and mortality. Implantable cardioverter-defibrillator shocks terminate VT but confer a significant morbidity and mortality risk. Therefore, VT ablation is increasingly common. Patients with structural heart disease (SHD) and patients with structurally normal hearts as well as the subgroup with and without ischemic heart disease were assessed for predictors of mortality and nonfatal VT recurrence. We present the first multicenter, prospective German VT registry. In 334 patients, 118 structurally normal hearts and 216 SHD (74.5% ischemic heart disease), referred for VT ablation in 38 centers, long-term follow-up was assessed for a minimum of 12 months and analyzed for factors predicting VT recurrence rates and mortality. The VTs in SHD patients were more frequently hemodynamically unstable (34.7% versus 12.7%, <0.0001) or incessant (9.7% versus 2.7%, <0.05). More SHD patients underwent substrate modification than patients...
Trends and Outcomes of Catheter Ablation for Ventricular Tachycardia in a Community Cohort
JACC. Clinical electrophysiology, 2018
This study examined the trend in growth of catheter ablation for ventricular tachycardia (VT) performed in the United States with analysis of rates and predictors of major adverse events. Sustained VT is a significant cause of sudden death, heart failure (HF), and recurrent shocks in implantable cardioverter-defibrillator (ICD) recipients. Catheter ablation for VT reduces arrhythmia recurrence. Limited data are available regarding the use, safety, and long-term outcomes after VT ablation. Using the U.S. Medicare database linked to the Social Security Death Index, we examined the annual use of VT ablation in 21,073 patients over 12 years, with 30-day risk of mortality, nonfatal major adverse events (MAEs), 1-year risk of mortality, re-hospitalization, repeat ablation, and factors associated with adverse outcomes. Among 21,073 patients (age 70 ± 9 years; 77% men; 90% white), there were 1,581 (7.5%) non-fatal MAEs within 30 days. There were 963 (4.6%) vascular complications, 485 (2.3%)...
Nationwide survey on the current practice of ventricular tachycardia ablation
Journal of Cardiovascular Medicine, 2019
Methods We performed a nationwide survey on the current practice of ventricular tachycardia catheter ablation in Italy during the year 2016. Results Among 145 operators participating in the survey, 58 (40.0%) did not perform any ventricular tachycardia ablation in 2016. Among those performing ventricular tachycardia ablation, 9 operators (6.2%) performed only right ventricular endocardial catheter ablation, 52 (35.9%) performed endocardial catheter ablation both in the right and left ventricle (LV) and 26 (17.9%) performed both endocardial and epicardial LV catheter ablations. Seventy operators (89.7%) among the 78 performing LV and epicardial ablations treated patients with ischemic cardiomyopathy; ablations in the setting of other causes were less frequently performed. The following were considered as minimum requirements for ventricular tachycardia ablation: presence of a three-dimensional mapping system (120 operators, 82.8%), ICU in the hospital (118 operators, 81.4%), operator's training in high volume centers (93 operators, 64.1%). Twenty-eight operators (19.3%) performed catheter ablation in patients with electrical storm only after hemodynamic stabilization, 41 operators (28.3%) also during the acute phase and 9 operators (6.2%) never performed catheter ablation in electrical storm patients; the remaining 67 operators did not perform ventricular tachycardia ablation at all, or performed ablations only in the right ventricle. Conclusion The present survey provides a snapshot of the current invasive treatment of ventricular tachycardia by catheter ablation. The procedure, especially in the setting of ischemic cardiomyopathy, is performed nationwide. Complex cases, including those with electrical storm, should be managed within a preestablished integrated network of regional referral centers able to transfer patients as soon as possible.
Heart rhythm : the official journal of the Heart Rhythm Society, 2014
There is a paucity of data regarding the complications and in-hospital mortality after catheter ablation for ventricular tachycardia (VT) in patients with ischemic heart disease. The purpose of this study was to determine the temporal trends in utilization, in-hospital mortality, and complications of catheter ablation of postinfarction VT in the United States. We used the 2002-2011 Nationwide Inpatient Sample (NIS) database to identify all patients ≥18 years of age with a primary diagnosis of VT (International Classification of Diseases, Ninth Edition, Clinical Modification [ICD-9-CM] code 427.1) and who also had a secondary diagnosis of prior history of myocardial infarction (ICD-9-CM 412). Patients with supraventricular arrhythmias were excluded. Patients who underwent catheter ablation were identified using ICD-9-CM procedure code 37.34. Temporal trends in catheter ablation, in-hospital complications, and in-hospital mortality were analyzed. Of 81,539 patients with postinfarct VT...
Open Heart, 2019
BackgroundVentricular tachycardia (VT) is associated with increased morbidity and mortality. There is growing evidence for the effectiveness of catheter ablation in improving outcomes in patients with recurrent VT. Consequently the threshold for referral for VT ablation has fallen over recent years, resulting in increased number of procedures.ObjectiveTo evaluate the effectiveness and safety of VT ablation in a real-world tertiary centre setting.MethodsThis is a prospective analysis of all VT ablation cases performed at University Hospital Coventry. Follow-up data were obtained from review of electronic medical records and patient interview. The primary endpoint for normal heart VT was death, cardiovascular hospitalisation and VT recurrence, and for structural heart VT was arrhythmic death, VT storm (>3 episodes within 24 hours) or appropriate shock.ResultsForty-seven patients underwent 53 procedures from January 2012 to January 2018. The mean age ±SD was 57±15 years, 68% were ma...
2013
at Subscriptions: Information about subscribing to Circulation: Arrhythmia and Electrophysiology is online by guest on April 16, 2013 circep.ahajournals.org Downloaded from 351 I n patients with ischemic cardiomyopathy (ICM), ventricular tachycardia (VT) is associated with poor long-term outcomes. 1 Three secondary prevention studies have shown the unequivocal benefit of implantable cardioverter-defibrillators (ICD) in patients with previous myocardial infarction and impaired left ventricular ejection fraction. 2-4 These studies, however, excluded patients with stable VT or with left ventricular ejection fraction >40%. Analysis from the antiarrhythmics versus implantable defibrillators registry, 5 however, suggests that clinically well-tolerated VT carries a poor prognosis as well. ICDs are therefore recommended in patients with previous myocardial infarction and sustained VT. 6 Although ICDs improve overall survival, they do not eliminate the substrate responsible for sustained arrhythmia. ICD without ablation carries a higher risk of shocks, 7,8 and shocks are associated with decreased quality of life and increased mortality. 9 VT ablation, on the contrary, reduces or even abolishes VT episodes in some patients. Currently, guidelines suggest that VT ablation to be used as an adjunct to ICD. 10 It is not known whether some patients presenting with VT can be treated by ablation alone.
Circulation. Arrhythmia and electrophysiology, 2018
Catheter ablation of ventricular tachycardia (VT) is effective to prevent arrhythmia episode-related implantable cardioverter defibrillator shocks. However, recurrences in noninducible patients at programmed ventricular stimulation (PVS) are substantial. From May 2013 to September 2015, 218 PVSs were performed 6 days (5-7) after ablation (186 noninvasive programmed stimulations and 32 invasive PVS) in 210 consecutive patients (ischemic, 48%; median left ventricular ejection fraction, 37%; syncope, 35% with trauma associated 6%), while patients were awake and under β-blocker therapy. After ablation, implantable cardioverter defibrillators were programmed according to noninvasive programmed stimulations results (class A-noninducible; class B-nondocumented inducible VT; and class C-documented inducible VT), with high and delayed VT detection intervals. Concordance between PVS end procedure and PVS day 6 was 67%. Positive predictive value and negative predictive value were higher for PV...