Acute Hemodynamic Decompensation During Catheter Ablation of Scar-Related Ventricular Tachycardia. (February 2015)

• Record Type: Journal Article
• Authors: Santangeli, Pasquale; Muser, Daniele; Zado, Erica S.; Magnani, Silvia; Khetpal, Sumun; Hutchinson, Mathew D.; Supple, Gregory; Frankel, David S.; Garcia, Fermin C.; Bala, Rupa; Riley, Michael P.; Lin, David; Rame, J. Eduardo; Schaller, Robert; Dixit, Sanjay; Marchlinski, Francis E.; Callans, David J.
• Is Part Of: Circulation. Volume 8:Number 1(2015)
• Publication Date: 2015-02
• Subjects: Arrhythmia -- Periodicals; Heart -- Electric properties -- Periodicals; 616.128
• DOI: 10.1161/CIRCEP.114.002155
• Languages: English
• ISSNs: 1941-3149

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background—</title> <p>The occurrence of periprocedural acute hemodynamic decompensation (AHD) in patients undergoing radiofrequency catheter ablation of scar-related ventricular tachycardia (VT) has not been previously investigated.</p> </sec> <sec> <title>Methods and Results—</title> <p>We identified univariate predictors of periprocedural AHD in 193 consecutive patients undergoing radiofrequency catheter ablation of scar-related VT. AHD was defined as persistent hypotension despite vasopressors and requiring mechanical support or procedure discontinuation. AHD occurred in 22 (11%) patients. Compared with the rest of the population, patients with AHD were older (68.5±10.7 versus 61.6±15.0 years; <italic>P</italic>=0.037); had a higher prevalence of diabetes mellitus (36% versus 18%; <italic>P</italic>=0.045), ischemic cardiomyopathy (86% versus 52%; <italic>P</italic>=0.002), chronic obstructive pulmonary disease (41% versus 13%; <italic>P</italic>=0.001), and VT storm (77% versus 43%; <italic>P</italic>=0.002); had more severe heart failure (New York Heart Association class III/IV: 55% versus 15%, <italic>P</italic><0.001; left ventricular ejection fraction: 26±10% versus 36±16%, <italic>P</italic>=0.003); and more often received periprocedural general anesthesia (59% versus 29%; <italic>P</italic>=0.004). At 21±7 months follow-up, the mortality rate was higher in the AHD group compared with the rest of the population (50% versus 11%, log-rank <italic>P</italic><0.001).</p> </sec> <sec> <title>Conclusions—</title> <p>AHD occurs in 11% of patients undergoing radiofrequency catheter ablation of scar-related VT and is associated with increased risk of mortality over follow-up. AHD may be predicted by clinical factors, including advanced age, ischemic cardiomyopathy, more severe heart failure status (New York Heart Association class III/IV, lower ejection fraction), associated comorbidities (diabetes mellitus and chronic obstructive pulmonary disease), presentation with VT storm, and use of general anesthesia.</p> </sec> </abstract>