PO-04-198 IMPROVED SAFETY OF CATHETER ABLATION FOR VENTRICULAR ARRHYTHMIA: A DECADES’ EXPERIENCE

Abstract

Ventricular arrhythmia (VA) is a major contributor to cardiovascular morbidity and mortality. Catheter ablation is an effective therapeutic intervention for VA and has been increasingly used. Understanding the evolution of procedural risk informs risk-benefit assessment and patient selection. Examine the evolution of the safety of catheter ablation for VA. We examined our institutional experience with VA catheter ablation including premature ventricular contraction (PVC) and ventricular tachycardia (VT) ablation. A total of 2,300 patients had VA ablation over the past decade from January 2009 to October 2022. Thirty-day major complication data were obtained by individual chart review and clinical patient follow-up, and stored in our prospective institutional database. Major complications were defined as intra- or post-procedural complications leading to additional procedures or prolonged hospital stay, or post-discharge complications requiring re-hospitalization. Three time periods (2009-2013, 2014-2018 and 2019-2022) were a priori selected to examine trends in thirty-day complication outcomes. Logistic regression was implemented to test for a trend in the rate of major complications over the three time periods. In our single-center cohort, 887, 896 and 517 patients underwent catheter ablation for VA between 2009-2013, 2014-2018 and 2019-2022, respectively. We found a consistent trend of overall decreased thirty-day major complications across the three pre-defined time periods for ventricular arrhythmia catheter ablation (p=0.006). The trend of decreasing incidence of major complications persisted when we examined PVC and VT ablations separately, however, it did not reach the threshold for statistical significance (Figure 1a). The cumulative incidence of major complications in the most contemporary era was 1.3% for PVC ablation, and 2.3% for VT ablation, respectively. The decrease in major complications was primarily driven by reduction in the rate of pericardial effusion, vascular complications and thromboembolism associated with VA catheter ablation (Figure 1b). Significant strides have been made in improving the safety profile of catheter ablation for VAs. These findings may inform patient selection as the proportion of patients with ventricular arrhythmia referred for catheter ablation increases.