82 * Ablation of ventricular tachycardia in the very elderly with cardiomyopathy

Abstract

Introduction: Ablation procedures for ventricular tachycardia (VT) have become the state-of-the-art treatment for patients with refractory symptomatic VT in the context of ischaemic or non-ischaemic cardiomyopathy. Some studies have suggested this procedure is feasible, safe and effective in the elderly population. We aim at evaluating the acute and post-acute effectiveness and safety of VT ablation in very elderly patients with ischaemic or non-ischaemic cardiomyopathy. Methods: All patients 80 years of age or older with previously known ischaemic or non-ischaemic cardiomyopathy admitted for VT ablation from January 1st 2008 to December 31st 2013 were included and followed for an average of 12 months (range 1-30 months). The following data were collected: demographic characteristics, medication, clinical and procedural information and follow-up data. Study endpoints were all-cause mortality and the occurrence of any significant VT, defined as the occurrence of any ICD therapy or any symptomatic VT regardless of ICD therapy. Results: Fourteen VT ablations in 13 patients with ischaemic or non-ischaemic cardiomyopathy were performed during the above-mentioned time period (mean age 84.2, range 80-92, 30.8% females, all but one with ischaemic cardiomyopathy, 46.1% with severe left ventricular dysfunction, 77% on either amiodarone or sotalol). All patients had the procedure due to either recurrent symptomatic VT and/or ICD shocks. Voltage mapping and late potentials were used to guide the ablation in all cases except one where the VT was of a bundle branch re-entry type. Complete success was achieved in 11 procedures, while in 2 cases the clinical VT was still inducible albeit with much more aggressive pacing protocols. The ablation failed in one case. No direct complications of any of the 14 procedures were reported. Seven patients died during follow-up: their mean and median additional months of life after VT ablation were 15.3 and 21, respectively. The remaining 6 patients are still alive (average follow-up of 6 months). Five patients had ventricular arrhythmia after the ablation procedure: 4 patients had ICD therapy delivered once (ATP in 3 cases, ATP plus shock in the remaining one), but only 2 had symptoms; an additional patient had one symptomatic VT that did not trigger ICD therapy, as the VT rate was below the programmed tachycardia zone. Conclusions: VT ablation is feasible and safe in very elderly patients with ischaemic or non-ischaemic cardiomyopathy. Acute and post-acute success rates seem similar to those described in the literature for their younger counterparts.