Correlates and Prognosis of Early Recurrence after Catheter Ablation for Ventricular Tachycardia due to Structural Heart Disease
Background—Catheter ablation for ventricular tachycardia (VT) from structural heart disease has a significant risk of recurrence, but the optimal duration for in hospital monitoring is not defined. This study assesses the timing, correlates, and prognostic significance of early VT recurrence after ablation.
Methods and Results—Of 370 patients (313 male; age 63.0±13.2 years) who underwent a first radiofrequency ablation for sustained monomorphic VT associated with structural heart disease from 2008 to 2012, sustained VT recurred in 81 patients (22%) within 7 days. In multivariable analysis early recurrence was associated with NYHA classification ≥ III (OR 1.90, 95% CI 1.03 to 3.48; P=0.04), DCM (OR 1.93, 95% CI 1.03 to 3.57; P=0.04), prevalence of VT storm before the procedure (OR 2.62, 95% CI 1.48 to 4.65; P=0.001), a greater number of induced VTs (OR 1.24, 95% CI 1.07 to 1.45; P=0.006) and acute failure or no final induction test (OR 1.88, 95% CI 1.03 to 3.40; P=0.04). During a median of 2.5 (1.2, 4.0) years of follow-up, early VT recurrence was an independent correlates of mortality (hazard ratio 2.59, 95% CI 1.52 to 4.34, P=0.0005).
Conclusions—Patients who have early recurrences of VT after ablation are a high risk group who may be identifiable from their clinical profile. Further study is warranted to define the optimal treatment strategies for this patient group.
- Received January 14, 2014.
- Revision received June 17, 2014.
- Accepted July 13, 2014.