Long-term Outcome Of Catheter Ablation Research Articles

Substrate Characterization and Outcomes of Ventricular Tachycardia Ablation in TTN (Titin) Cardiomyopathy: A Multicenter Study.

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Left Atrial Wall Stress and the Long-Term Outcome of Catheter Ablation of Atrial Fibrillation: An Artificial Intelligence-Based Prediction of Atrial Wall Stress.

Atrial stretch may contribute to the mechanism of atrial fibrillation (AF) recurrence after atrial fibrillation catheter ablation (AFCA). We tested whether the left atrial (LA) wall stress (LAW-stress[measured]) could be predicted by artificial intelligence (AI) using non-invasive parameters (LAW-stress[AI]) and whether rhythm outcome after AFCA could be predicted by LAW-stress[AI] in an independent cohort. Cohort 1 included 2223 patients, and cohort 2 included 658 patients who underwent AFCA. LAW-stress[measured] was calculated using the Law of Laplace using LA diameter by echocardiography, peak LA pressure measured during procedure, and LA wall thickness measured by customized software (AMBER) using computed tomography. The highest quartile (Q4) LAW-stress[measured] was predicted and validated by AI using non-invasive clinical parameters, including non-paroxysmal type of AF, age, presence of hypertension, diabetes, vascular disease, and heart failure, left ventricular ejection fraction, and the ratio of the peak mitral flow velocity of the early rapid filling to the early diastolic velocity of the mitral annulus (E/Em). We tested the AF/atrial tachycardia recurrence 3 months after the blanking period after AFCA using the LAW-stress[measured] and LAW-stress[AI] in cohort 1 and LAW-stress[AI] in cohort 2. LAW-stress[measured] was independently associated with non-paroxysmal AF (p < 0.001), diabetes (p = 0.012), vascular disease (p = 0.002), body mass index (p < 0.001), E/Em (p < 0.001), and mean LA voltage measured by electrogram voltage mapping (p < 0.001). The best-performing AI model had acceptable prediction power for predicting Q4-LAW-stress[measured] (area under the receiver operating characteristic curve 0.734). During 26.0 (12.0–52.0) months of follow-up, AF recurrence was significantly higher in the Q4-LAW-stress[measured] group [log-rank p = 0.001, hazard ratio 2.43 (1.21–4.90), p = 0.013] and Q4-LAW-stress[AI] group (log-rank p = 0.039) in cohort 1. In cohort 2, the Q4-LAW-stress[AI] group consistently showed worse rhythm outcomes (log-rank p < 0.001). A higher LAW-stress was associated with poorer rhythm outcomes after AFCA. AI was able to predict this complex but useful prognostic parameter using non-invasive parameters with moderate accuracy.

Safety and long-term outcomes of catheter ablation according to sex in patients with atrial fibrillation: A nationwide cohort study

BackgroundCatheter ablation is more effective than antiarrhythmic drug therapy alone in patients with atrial fibrillation (AF). However, there are limited data on the outcomes of AF ablation according to sex. The purpose of this study was to evaluate gender differences in the actual outcomes after catheter ablation for atrial fibrillation. MethodsOf 801,710 patients with AF in the Korean National Health Insurance Service database, we identified 9175 patients without valvular heart disease who underwent AF ablation between 2006 and 2015 and assessed 30-day safety and one-year effectiveness outcomes according to sex. ResultsOf the 9175 patients who underwent AF ablation, 2206 (24%) were female. Women, compared to men, were older (60.8 ± 10.2 vs. 56.0 ± 10.5 years), had higher CHA2DS2-VASc (3.5 ± 1.7 vs. 2.0 ± 1.6), higher HAS-BLED (2.6 ± 1.3 vs. 2.4 ± 1.2), and higher Charlson comorbidity index scores (3.8 ± 2.6 vs. 3.1 ± 2.5) (p < 0.001 for all). Following ablation, there was no significant difference in the risk of 30-day complications, including hemorrhage and tamponade, between women and men. In multivariable analyses, there were no significant differences in all-cause hospitalization (adjusted hazard ratio [HR] 1.05, 95% confidence interval [CI] 0.91–1.22, p = 0.489) and AF rehospitalization (adjusted HR 1.16, 95% CI 0.96–1.40, p = 0.135). Women were less likely to undergo cardioversion (adjusted HR 0.72, 95% CI 0.62–0.84, p < 0.001) but were more likely to be re-hospitalized for heart failure (adjusted HR 1.86, 95% CI 1.11–3.11, p = 0.019). ConclusionWomen who underwent AF ablation did not differ from men in terms of the risk of complications and all-cause hospitalization in this study. The small increased risk in women reported in previous studies may be related to residual confounding, particularly from insufficient control for age and comorbidities.

Clinical characteristics and long-term outcomes of catheter ablation in young adults with atrial fibrillation.

We aim to describe the long-term safety and efficacy of catheter ablation (CA) in young patients (<30 years) with atrial fibrillation (AF). This was a retrospective study of patients aged 18-30 who underwent CA for AF, and clinical characteristics and long-term outcomes are reported. Survival analyses were performed between the study group and a propensity-matched older cohort (>30 years, mean age: 58±10 years). From January 2000 to January 2019, a 1st CA (radiofrequency energy n=72, cryoballoon n=10), was performed in 82 patients (mean age 26±4 years, paroxysmal n=61, persistent n=14, longstanding persistent n=7), among 6336 consecutive patients with AF. During a follow-up of 5±5 years, 56% and 30% of the patients with paroxysmal and non-paroxysmal AF were arrhythmia free without antiarrhythmic drug (AAD) therapy after a single CA (P=0.02). After 1.5±0.8 CA procedures, 76% and 75% of the patients with paroxysmal AF and non-paroxysmal AF were arrhythmia free without AADs (P=0.54). Compared to a propensity-matched group of older patients, young patients were as likely to remain in sinus rhythm after CA (P=0.47), however after fewer repeat CAs (1.5±0.8 vs 1.9±0.9, P<0.009). There were no long-term adverse outcomes associated with CA. CA is a safe and effective treatment of AF in young patients with comparable outcomes to the older patients, however after fewer procedures.

Advanced glycation end products predict long-term outcome of catheter ablation in paroxysmal atrial fibrillation.

Oxidative stress is an important contributor to the etiology of atrial fibrillation (AF). Our aim was to study oxidative stress biomarkers in patients undergoing pulmonary vein isolation (PVI) for paroxysmal AF with radiofrequency catheter ablation and to assess its prognostic value in predicting long-term PVI outcome. In this prospective cohort study, we included 62 patients (mean age 55±8 years, 12 females and 50 males) with paroxysmal AF and implanted ECG loop recorders who underwent PVI. Plasmatic concentrations of advanced glycation end-products (AGEs), fructosamine, advanced oxidation protein products, and thiobarbituric-acid reacting substances were measured before PVI. AF burden (percentage of time spent in AF) was continually assessed during the follow-up period (1063±271 days). Nineteen patients (31%) were defined as optimal responders (oR) with AF burden < 0.5% after PVI. Remaining 43 patients (69%) were defined as sub-optimal responders. Concentration of AGEs was significantly lower in oR by 3.7 g/g (CI: -6.5 to -1.7; P=0.0003). After adjustment for age, sex, BMI, left atrial size, arterial hypertension, and AF burden before PVI, only low concentration of AGEs remained significantly associated with oR (odds ratio: 1.3; P=0.04). AGEs concentration achieved area under the curve of 0.78 for predicting optimal long-term PVI response. AGEs concentration before PVI was associated with long-term PVI outcome in patients with paroxysmal AF. Further research will show if this biomarker could contribute to optimal patient selection for catheter ablation.

The shape of the left lateral ridge as a predictor of long-term outcome of catheter ablation for atrial fibrillation based on clinical and experimental data

BackgroundThe left lateral ridge (LLR) is an important structure for ablation of atrial fibrillation (AF). This study assessed how the LLR shape is associated with the long-term outcomes of AF ablation and investigated the relationship with radiofrequency (RF) lesion formation. Methods and resultsClinical study - we assessed multi-detector computed tomography (MDCT) images in 247 patients who underwent AF ablation. Patients were classified into two groups according to the shape of the LLR: Narrow LLR group (n = 116; 47%) and Wide LLR group (n = 131; 53%). After a follow-up period 475 ± 245 days, the AF-free rate was significantly higher in the wide LLR than Narrow LLR group (83.2% vs. 62.9%, p = 0.0004). A multivariate analysis showed that the shape of the LLR was an independent predictor of AF recurrence after ablation (hazard ratio 2.58; 95% confidential interval = 1.48–4.51, p = 0.001).Experimental study - Two types of the ridge models were made with porcine atrial tissues: “Narrow ridge(4.2 ± 0.9 mm)” and “Wide ridge(9.7 ± 1.8 mm)” RF ablation was performed on each ridge model using a contact force (CF)-sensing catheter. The mean CF and the RF lesion volume of the narrow ridge were significantly less than those of the wide ridge model (5.42 ± 3.13 g vs. 10.37 ± 3.98 g, p = 0.001; 19.8 ± 9.9 mm3 vs. 44.2 ± 13.6 mm3, p < 0.001, respectively). ConclusionsAF recurrence after ablation was more frequent in patients with a narrow LLR. LLR shape as assessed using MDCT is associated with long-term outcomes after AF ablation. CF and lesion formation data using the porcine atrial tissue model support our clinical results.

Left Atrial Appendage Electrical Isolation Reduces Atrial Fibrillation Recurrences: A Simulation Study.

Left Atrial Appendage Electrical Isolation Reduces Atrial Fibrillation Recurrences: A Simulation Study.

Meta-analysis comparing outcomes of catheter ablation for ventricular arrhythmia in ischemic versus nonischemic cardiomyopathy.

BackgroundCatheter ablation is an effective treatment for ventricular arrhythmia (VA) in ischemic cardiomyopathy (ICM). However, results in non‐ICM (NICM) patients are not satisfactory, and studies comparing differences between NICM and ICM are limited. We conducted a meta‐analysis of procedural characteristics and long‐term outcomes of catheter ablation for VA, comparing results between ICM and NICM.MethodsStudies in the PubMed, EMBASE, and Cochrane databases were systematically reviewed. Four studies reporting comparison of catheter ablation of VA between ICM and NICM were examined. The Newcastle‐Ottawa Scale was used to appraise study quality. A random‐effects model with inverse variance method was used for comparisons.ResultsEpicardial approach was significantly more undertaken for the NICM group than in the ICM group (odds ratio [OR]: 0.13; 95% confidence interval [CI]: 0.09‐0.18; P < .00001). Mean ablation time (P = .54), fluoroscopy time (P = .55), and procedural time (P = .18) did not differ significantly between the ICM and NICM groups. Procedural failure rates (OR: 0.46; 95% CI: 0.24‐0.89; P = .02) and VA recurrence rates (risk ratio [RR]: 0.68; 95% CI: 0.46‐1.01; P = .06) were significantly higher in the NICM group than in the ICM group. However, all‐cause mortality (RR: 1.37; 95% CI: 0.75‐2.49; P = .31) did not differ significantly between groups.ConclusionsProcedural failure and VA recurrence rates were significantly higher in the NICM group, despite significantly more frequent epicardial access. These highlight the limitations of catheter ablation for VA in NICM, given our current knowledge.

Catheter ablation of ventricular tachycardia in the pediatric patients: A single-center experience.

Ventricular tachycardia (VT) with or without structural heart disease is uncommon but well-recognized clinically in children. With this retrospective study, we collected the data from the in-hospital pediatric patients of VT with catheter ablation therapy. The purpose of this study is to assess the acute results and the long-term outcome of catheter ablation in pediatric patients of VT in our single pediatric center. This study included 53 consecutive children (male/female=33/20, mean age=8.2±3.4 years, mean bodyweight=32.6±13.7kg). All patients underwent electrophysiological study with an attempt of catheter ablation for clinical monomorphic VT. Acute and long-term success rate of catheter ablation for the treatment of VT were compared between right and left VT as well as fascicular VT (FVT) and nonfascicular VT. There were 53 idiopathic VT forms found in the children, including FVT (n=32), outflow tract VT (n=15), papillary muscle VT (n=5), and bundle branch reentry VT (n=1). Acute success of catheter ablations for VT was achieved in 57 of all the 59 ablation procedures (97%) with VT recurrence occurred in six of 53 patients (11%). During a mean follow-up period of 29.2±21.7 months (range 1-76 months) after hospital discharge, ablations in nonfascicular VT were as successful as FVT. There was no significant difference in the success rate between the right and left VT. Catheter ablation is an effective treatment for idiopathic VT in children. The acute and long-term success rates of catheter ablation for idiopathic VT in pediatric patients with normal heart structure are satisfying.

Catheter ablation for monomorphic ventricular tachycardia in Brugada syndrome patients: detailed characteristics and long-term follow-up.

Brugada syndrome (BrS) is a risk of sudden cardiac death due to polymorphic ventricular tachycardia and ventricular fibrillation with unusual monomorphic ventricular tachycardia (MVT). Detailed characteristics of MVT and long-term outcome of catheter ablation are still unknown. This study is aimed to identify the detailed characteristics and long-term follow-up of catheter ablation in BrS patients. We evaluated 188 patients who were diagnosed with BrS from March 1999 to March 2018. Of those, patients who developed MVT and underwent catheter ablation were included. We identified eight MVTs in seven BrS patients. Three of them already had implantable cardioverter-defibrillator, and MVTs were terminated by cardioversion or anti-tachycardia pacing. Four patients presented with MVT originating from the right ventricular outflow tract, one patient had MVT arising from the LV septum, one patient had MVT arising from the tricuspid annulus, and one patient had bundle branch reentry ventricular tachycardia. All MVTs were successfully treated by catheter ablation in the acute phase, and seven of eight (87.5%) were free from ventricular tachyarrhythmia during the long-term follow-up (median, 7.2years). All MVT cases were successfully treated by catheter ablation. We observed high ventricular arrhythmia free rate following catheter ablation during the long-term follow-up period. BrS patients who developed MVT should consider catheter ablation.

Long-term outcome of catheter ablation in post-infarction recurrent ventricular tachycardia

Objectives. Severe LV dysfunction and advanced age are associated with VT recurrence after catheter ablation in patients with post-infarction drug-refractory VT. We present retrospective analysis of long-term outcome after single and repeat VT ablation procedures in patients with ischemic heart disease. Design. Patients with recurrent VT post infarction who underwent catheter ablation between 2006 and 2017 in Isala Heart Centre were retrospectively analyzed. Univariate and multivariate analysis were used to identify predictors of arrhythmia recurrence post ablation. Patients were allocated to subgroups based on LVEF: severe (<30%), moderate (30–40%) and mild LV dysfunction (41–51%) and analyzed with log rank test. Results. A total of 144 patients were included. Two years VT free survival after a single procedure was 56.6% with median follow-up 46 [17–78] months. Recurrence of VT postablation wash high among patients with an old anteroseptal MI and LVEF < 30% with multiple morphologies of inducible VTs, indicating an extensive and complex substrate. Patients who underwent repeat ablations (27.1%) had significant more often LV aneurysms (20.5% vs. 7.6%, p = .03) and electrical storms (38.5% vs. 21.9%, p = .04). VT free survival was higher in patients with LVEF 41–51% compared to LVEF < 30% (71.4% vs. 47.8%, p = .01). In multivariate analysis, LVEF < 30% (vs 41–51%) was an independent predictor of arrhythmia recurrence (HR = 2.16, CI 1.15–4.06, p = .02). Conclusions. In patients with ischemic VT, success rate of ablation was highest among patients with preserved LV function and recurrent VT and ES was highest among patients with severe LV dysfunction after single and multiple ablation procedures.

Long-term outcome of catheter ablation for atrial tachyarrhythmias in patients with atrial septal defect.

This study aimed to evaluate efficacy, safety, and long-term outcome of radiofrequency catheter ablation (RFCA) for atrial tachyarrhythmia (ATa) in patients with atrial septal defect (ASD). Seventy-five ASD patients with ATa (52% atrial fibrillation, AF) were enrolled. Electrophysiological study and RFCA were performed, with endpoints of index and multiple procedures as follows: (a) atrial tachycardia/atrial flutter (AT/AFL), absence of inducibility of any atrial arrhythmia and (b) AF, circumferential pulmonary vein ablation (CPVA, paroxysmal AF), bidirectional block of lines, and disappearance of complex fractionated atrial electrograms (persistent and long-standing persistent (LSP)-AF). Cumulative success rate at 1-year follow-up was 79.9% and dropped to 59.0% at a median follow-up of 63months (range, 14-114months) for multiple procedures (mean 1.6 ± 0.7 [1-3]). Freedom from ATa after multiple procedures was achieved in 75% patients with AT/AFL and 43.6% patients with AF (P = 0.006 for comparison). In multivariate analysis, older age at ASD correction (HR, 1.033 [95% CI, 1.008-1.059]; P = 0.01), ASD diameter before correction (HR, 1.054 [95% CI, 1.006-1.105]; P = 0.027), and first-diagnosed ATa type (AF; HR, 2.25 [95% CI, 1.03-4.92]; P = 0.042) were significant independent predictors of ATa recurrence. Patients with more risk factors had higher risk of ATa recurrence. The long-term outcome of RFCA for ATa outcome was favorable for AT/AFL while mediocre for AF. ATa recurrence was more common in patients with older age at ASD correction, larger ASD diameter before correction, and first-diagnosed AF. Patients with more risk factors had higher ATa recurrence risk.

Long-Term Outcomes of Catheter Ablation of Ventricular Tachycardia in Patients With Ischemic Cardiomyopathy

Long-Term Outcomes of Catheter Ablation of Ventricular Tachycardia in Patients With Ischemic Cardiomyopathy

Outcomes of Catheter Ablation in Arrhythmogenic Right Ventricular Cardiomyopathy Without Background Implantable Cardioverter Defibrillator Therapy: A Multicenter International Ventricular Tachycardia Registry.

This study sought to determine the long-term outcomes of catheter ablation (CA) of ventricular tachycardia (VT) in a series of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) without background implantable cardioverter-defibrillator (ICD) therapy. Endo-epicardial CA of VT has been demonstrated to be highly effective in reducing recurrent VT in patients with ARVC. Thirty-two patients (age 45 ± 13 years, 72% male) with ARVC and VT underwent CA in the absence of ICD therapy. ICD was recommended in all cases, but implantation was not performed due to patient refusal (63%) or financial hardship (37%). CA was guided by activation/entrainment mapping for mappable VT and pace mapping/targeting of abnormal substrate in cases of unmappable VT. Symptoms associated with clinical VT included palpitations (78%), chest pain and shortness of breath (22%), pre-syncope (16%), and syncope (13%). Prior to ablation, 22 patients (69%) failed a mean of 1.3 ± 0.5 antiarrhythmic drugs. Epicardial mapping and ablation was performed as first-line strategy (20 [63%]) or in case of recurrent VT or persistent inducibility after endocardial-only ablation (3 [9%]-surgical epicardial cryoablation in 1 patient). After a mean of 1.6 (range 1 to 3) procedures, all patients demonstrated noninducibility of sustained VT from at least 2 RV sites; 75% also had stimulation on isoproterenol with no inducible VT. At a median follow-up of 46 months (range 26 to 65 months) following the last ablation, no deaths were observed and freedom from recurrent VT was 81%. In this multicenter international registry of patients with ARVC and VT, CA performed in the absence of background ICD was associated with a low rate of symptomatic VT recurrence (19%) without mortality during 46-month median follow-up. These data suggest that further prospective studies may refine selection of patients with structural heart disease at low risk for SCD, possibly obviating the benefit of ICD therapy.

Long-term outcomes of catheter ablation in patients with longstanding persistent atrial fibrillation lasting less than 2 years.

Outcome data after catheter ablation (CA) for longstanding persistent atrial fibrillation (LSPAF) lasting less than 2 years are limited and highly variable with different ablation approaches. We aimed to assess the long-term outcomes in patients with LSPAF lasting less than 2 years undergoing extended pulmonary vein antrum isolation (PVAI) versus those with additional non-pulmonary vein (PV) trigger ablation. In this prospective analysis, 381 consecutive patients with LSPAF lasting less than 2 years (age: 64 ± 9 years, 76% male, atrial fibrillation duration: 19 ± 5 months) undergoing their first CA were classified into two groups: Group 1 (n = 104) received PVAI extended to PW plus isolation of superior vena cava (SVC) and Group 2 ( n = 277) received PVAI + PW + SVC + non-PV-trigger ablation. All patients were followed-up for at least 2 years. In case of recurrence, repeat procedure was offered and non-PV triggers were targeted for ablation in all. After a single procedure, 26 (25%) patients in Group 1 and 172 (62.1%) in Group 2 remained arrhythmia-free (P < 0.001). A second procedure was performed in 58 of 78 (74.4%) patients in Group 1 and 77 of 105 (73.3%) patients in Group 2. Non-PV triggers were identified in 52 (89.6%) and 54 (70.1%) patients in Groups 1 and 2, respectively, and targeted for ablation. Overall, 72 (69.2%) patients in Group 1 and 238 (86%) in Group 2 remained arrhythmia-free ( P < 0.001). In patients with LSPAF lasting less than 2 years, extended PVAI plus SVC isolation was less likely to achieve long-term sinus rhythm. In the majority of patients, recurrence was due to non-PV triggers and ablation of those resulted in better outcome.

P1911The impact of manual vs remote magnetic navigation in the very long-term outcomes of catheter ablation of atrial fibrillation: a propensity score analysis

P1911The impact of manual vs remote magnetic navigation in the very long-term outcomes of catheter ablation of atrial fibrillation: a propensity score analysis

Long-term outcome of catheter ablation for atrial fibrillation in patients with apical hypertrophic cardiomyopathy.

To assess the long-term outcome of catheter ablation in patients with hypertrophic cardiomyopathy (HCM), especially in patients with apical HCM (ApHCM). From 9,249 AF ablation cases, 97 patients (28 with ApHCM and 69 with non-ApHCM) were enrolled. Another 97 patients matched by age, AF type, AF duration, and left atrial diameter were selected as the control group. After a mean follow-up of (44.3 ± 29.6) months, success rate after a single procedure was 42.9% in the ApHCM patients (P=0.725), 36.2% in the non-ApHCM patients (P=0.136) versus 50.5% in the control group. After multiple procedures, success rate both in the ApHCM group (50%, P=0.047) and in the non-ApHCM group (50.4%, P=0.017) were lower than in the controls (68.0%). More patients in the ApHCM and in the non-ApHCM group suffered very late recurrence beyond 1 year after the index procedure. Left atrial diameter (hazard ratio [HR] 1.04, 95% confidential interval [CI] 1.01-1.08, P=0.018) and AF duration (HR 1.01, 95% CI 1.00-1.01, P=0.005) were independent predictors of recurrence after the index ablation. There was no difference in thromboembolic events between the HCM group and the control group (8.2%vs. 3.1%, P=0.082). Patients with ApHCM or non-ApHCM had similar success rate of AF ablation after single procedure and lower success rate after multiple procedure compared with the control group.

GENDER-SPECIFIC VARIATION IN PULMONARY VEIN RECONNECTION RATE AFTER CATHETER ABLATION FOR ATRIAL FIBRILLATION

Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation for atrial fibrillation (AF). However, the single-procedure success rate is up to 77%; PV reconnection being the major cause of failure of this approach. Long-term outcome of catheter ablation is known to be different between men

Long-Term Outcome of Catheter Ablationfor Treatment of Bundle BranchRe-EntrantTachycardia.

This study reports the long-term outcome of patients with bundle branch re-entrant tachycardia (BBRT) who underwent catheter ablation for ventricular tachycardia (VT). BBRT is an uncommon mechanism of VT. Data on long-term outcomes of patients with BBRT treated with catheter ablation are insufficient. Between 2005 and 2016, 32 patients had a sustained VT due to a bundle branch re-entrant mechanism. Diagnosis of BBRT was established per standard published criteria. The mode of presentation was syncope in 17 patients (53%) and palpitations in 15 (47%). BBRT was inducible in all subjects, and successful ablation of the right bundle branch in 19 patients (59%) or the left bundle branch in 13 patients (41%) was performed. During follow-up of 95 ± 36 months, 6 patients (19%) died, 3 of progressive heart failure and 3ofnoncardiac causes. Recurrent VT due to BBRT did not occur in any patient. At baseline, 25 patients (78%) had a prolongedHV interval (>55 ms) and 7 (22%) had a normal HV interval (≤55 ms). In patients with a normal HV interval, there was only 1 death (due to malignancy), and no one developed heart block during 90 ± 36 months of follow-up. Ten patients (31%) had normal left ventricular (LV) function (LV ejection fraction≥50%), and 22 (69%) had depressed LV function (LVejection fraction<50%). No deaths were recorded in patients with normal LV function (5 with no implantable cardioverter-defibrillator) compared with 6 deaths among patients with depressed LV function (n= 22; p= 0.07). Radiofrequency ablation of the bundle branch is an effective therapy for treatment of BBRT. Sustained BBRTcanbe seen in patients with normal LV systolic function and HV interval with excellent long-term outcomes afterablation.

Long-term outcome of catheter ablation and other form of therapy for electrical storm in patients with implantable cardioverter-defibrillators

PurposeRadiofrequency catheter ablation (RFCA) for electrical storm (ES) has become a widely used therapeutic method. Its effectiveness in comparison to other forms of ES treatment is however uncertain.MethodsThis single-centre retrospective study investigated the long-term clinical outcome after RFCA for ES and compared long-time effects of ablation to other forms of treatment. The study population consisted of 70 consecutive patients hospitalised between January 2010 and June 2015 due to ES. Patients were recruited for the study if the following criteria were fulfilled: first ES caused by ventricular tachycardia (VT) or ventricular fibrillation (VF), implanted cardioverter defibrillator or cardiac resynchronisation therapy device and left ventricular ejection fraction < 50%. The follow-up data on VT/ES recurrence was obtained from pacemaker/implanted cardioverter defibrillator memory. Data on all-cause mortality was collected during outpatient visits or by telephone contact.ResultsOf the 70 patients enrolled, 28 (40%) were treated with RFCA (group A) and 42 (60%) received other forms of treatment for ES (group B). During a mean (±SD) 864 (629) days of follow-up, death occurred in 4 (14.3%) patients in the ablation group and in 16 (38.1%) patients treated with other methods [p = 0.03]. There was no significant between-group difference in VT/VF and ES recurrence. Statistical analysis revealed that the presence of cardiac resynchronisation therapy device during ES, stroke and/or transient ischaemic attack and lower baseline hematocrit level were the multivariate predictors of all-cause mortality.ConclusionsIn patients treated with RFCA for ES, all-cause mortality was significantly lower compared to the group treated with other methods.