Management of Ventricular Tachycardia in the Setting of a Dedicated Unit for the Treatment of Complex Ventricular Arrhythmias: Long-Term Outcome After Ablation

• Published in: Circulation (New York, N.Y.) N.Y.), 2013-04, Vol.127 (13), p.1359-1368
• Main Authors: DELLA BELLA, Paolo, BARATTO, Francesca, ALFIERI, Ottavio, PAPPALARDO, Federico, ZANGRILLO, Alberto, MACCABELLI, Giuseppe, TSIACHRIS, Dimitris, TREVISI, Nicola, VERGARA, Pasquale, BISCEGLIA, Caterina, PETRACCA, Francesco, CARBUCICCHIO, Corrado, BENUSSI, Stefano, MAISANO, Francesco
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Blood and lymphatic vessels; Cardiac dysrhythmias; Cardiology. Vascular system; Catheter Ablation - methods; Catheter Ablation - mortality; Catheter Ablation - trends; Cohort Studies; Disease Management; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Follow-Up Studies; Heart; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Hospital Units - trends; Humans; Male; Medical sciences; Middle Aged; Patient Admission - trends; Prospective Studies; Tachycardia, Ventricular - diagnosis; Tachycardia, Ventricular - mortality; Tachycardia, Ventricular - therapy; Time Factors; Treatment Outcome
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.112.000872

We investigated the impact of catheter ablation on ventricular tachycardia (VT) recurrence and survival in a large number of patients with structural heart disease treated in the setting of a dedicated multiskilled unit. Since January 2007, we have implemented a multidisciplinary model, aiming for a comprehensive management of VT patients. Programmed ventricular stimulation was used to assess acute outcome. Primary end points were VT recurrence and the occurrence of cardiac and sudden cardiac death. Overall, 528 patients were treated by ablation (634 procedures; 1-4 procedures per patient). Among 482 tested with programmed ventricular stimulation after the last procedure, a class A result (noninducibility of any VT) was obtained in 371 patients (77%), class B (inducibility of nondocumented VT) in 12.4%, and class C (inducibility of index VT) in 10.6%. After a median follow-up time of 26 months, VT recurred in 164 (34.1%) of 472 patients. VT recurrence was documented in 28.6% of patients with a class A result versus 39.6% of patients with class B and 66.7% with class C result (log-rank P