Utilization and complications of catheter ablation for ventricular arrhythmias in patients with mechanical valves. (14th October 2021)

• Record Type: Journal Article
• Authors: Rozen, G; Elbaz-Greener, G; Andria, N; Heist, E K; Ruskin, J N; Wijeysundera, H C; Carasso, S; Birati, E; Amir, O; Marai, I
• Is Part Of: European heart journal. Volume 42(2021)Supplement 1
• Publication Date: 2021-10-14
• Subjects: Catheter Ablation of Arrhythmias; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehab724.0372
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: Catheter ablation (CA) for ventricular arrhythmias (VAs) is increasingly utilized in the recent years. Ablation for VAs in patients with mechanical valves (MVs), can be challenging due to the chronic anticoagulation therapy, limitations in accessing the cardiac chambers, the risk for entrapment of mapping or ablation catheters between the leaflets of MVs and more. Purpose: To investigate the nationwide trends in utilization and complications of CA for VAs in patients with prior MVs. Methods: We drew data from the US National Inpatient Sample database to identify cases of VA ablations, including premature ventricular contraction (PVC) and ventricular tachycardia (VT) ablations, in patients with MVs between 2003 and 2015. Sociodemographic and clinical data were collected, and incidence of catheter ablation complications, mortality, and length of stay were analyzed. We compared the outcomes to a propensity matched cohort of patients without prior valve surgery. Results: The study population included a weighted total of 647 CA cases in patients with prior MVs. The annual number of ablations almost doubled, from 34 ablations on average during the "early years" (2003–2008) to 64 annual ablation procedures on average during the "late years" (2009–2015) of the study (p=0.001). Length of stay at the hospital did not differ significantly between patients with MVs and 649 matched patients without prior MVs (5.4±0.4, 4.7±0.3 days respectively, p=0.12). The incidence of complications was higher among patients with and without MVs (12.6% vs. 7.5% respectively, p=0.14), however, not reaching statistical significance. Moreover, the data revealed a trend toward higher mortality among patients with MVs undergoing CA compared to matched control patients without MVs (3.7% vs. 0.7% respectively, p=0.087). Conclusion: The utilization of catheter ablations for ventricular arrhythmias in patients with mechanical valves increased substantially over the years. The data show a trend towards increased incidence of morality and complications in the study population, requiring further investigation in larger population cohort. Funding Acknowledgement: Type of funding sources: Public hospital(s). Main funding source(s): Padeh Medical Center Research Fund