Complications, procedure-related and in-hospital mortality after catheter ablation for ventricular tachycardia in ischemic and non-ischemic dilated cardiomyopathy

Abstract

Purpose: Radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) in ischemic (ICM) and non-ischemic dilated cardiomyopathy (DCM) is a demanding and complex procedure, often performed in critically ill patients and carries a potential risk for procedure-related complications and death. Yet, successful VT ablation is in many cases crucial for achieving electrical and hemodynamic stability in patients with recurrent drug-refractory VT. Methods: The objective of the study was to investigate the safety of RFCA of scar related VT, as well as to estimate the incidence and the predictors for intrahospital mortality after VT ablation. A cohort of two hundred and twenty-seven (227) consecutive patients with ICM and non-ischemic DCM (197 pts. male; mean age 65.1±11.7 y; EF% 32.7±11.2; 72.2% with ICM), ablated for recurrent sustained VT were analysed. Results: The overall complication rate was 15% and major complications rate was 8.8%. Procedure-related death occurred in one case (0.44%). The commonest complications were vascular injury 4.4%, followed by pericardial effusion 2.2%, high-grade AV block 1.8%, pneumonia with respiratory insufficiency 1.3%, cardiogenic shock in 1.3%. Patients with heparin dose > 100 UI/kg have significantly more pericardial effusions, including 2 tamponades. Nine patients (4%) died during the hospitalisation period. The incomplete procedural success was a predictor for intra - hospital mortality HR 11.76; CI 95% 1.77-77.98; p=0.011; as well as the NYHA class heart insufficiency with HR 8.18; CI 95% 2.05-32.6; p=0.003. Conclusion: The RFCA of scar related VT is associated with a moderate incidence of major complications, but with a low procedure-related mortality. The incomplete ablation result is an independent predictor of intra-hospital mortality.