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CLINICAL PREDICTORS OF LONG-TERM MORTALITY AFTER FIRST ABLATION OF VENTRICULAR TACHYCARDIA IN PATIENTS WITH STRUCTURAL HEART DISEASE

P. Stojadinović, D. Wichterle, P. Peichl, J. Hašková, E. Borišincová, P. Štiavnický, A. Ševčík, E. Sinčaková, R. Čihák, J. Kautzner (Praha, IKEM)
Topic: Heart rhythm disorders
Type: Presentation - doctors, CCVRID 2023

Background
Catheter ablation is a well-established treatment modality for a wide spectrum of ventricular tachycardias (VTs). However, in the presence of structural heart disease (SHD), the prognosis and long-term mortality remains poor.

Objective
The aim of this study was to investigate the predictors of all-cause mortality after SHD-VT ablation in a high-volume expert center.

Methods
We evaluated 1143 patients (age: 63 ± 13 years, males: 87%, ICM: 67%, ES: 25%, NYHA Class: 2.1 ± 1.0, LVEF: 34 ± 13%, DM: 32%, COPD: 12%) who underwent first ablation for SHD-related VT between August 2006 and December 2020. Univariate and multivariate Cox-regression analyses were used to assess the predictors of all-cause mortality.

Results
At mean follow-up of 4.1 years (IQR: 2.0 – 7.2yrs) an all-cause mortality was 48%. A total of 320 patients (28%) underwent repeated VT ablation. The averaged PAINESD score of our cohort was 11.4 ± 6.6 (median: 12, IQR: 6–17). Univariate Cox-regression analysis revealed eight parameters associated with poor mortality (Figure). After multivariate adjustment, only age >60 years (HR: 1.82, 95% CI: 1.4–2.2, p < 0.0001), ischemic cardiomyopathy (HR: 1.48, 95% CI: 1.1–1.8, p < 0.001), NYHA class ≥ III (HR: 1.6, 95% CI: 1.3–1.9, p < 0.0001), a serum creatinine level >1.3 mg/dL (HR: 1.7, 95% CI: 1.4–2.0, p <0.00001), LVEF ≤25% (HR: 2.2, 95% CI: 1.8–2.6, p < 0.00001) and diabetes mellitus (HR: 1.4, 95% CI: 1.1–1.6, p < 0.001) were strong and independent predictors of mortality.

Conclusion
In a large cohort of patients after SHD-VT ablation, an advanced age, poor ejection fraction, ischemic cardiomyopathy, high NYHA class and diabetes mellitus but not electrical storm or COPD were independent and strong predictors of long-term all-cause mortality.