Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Australia.
Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Australia.
Int J Cardiol. 2023 Sep 1;386:50-58. doi: 10.1016/j.ijcard.2023.05.035. Epub 2023 May 22.
There is a paucity of data describing mortality after catheter ablation of ventricular tachycardia (VT).
We describe the causes and predictors of cardiac transplant and/or mortality following catheter ablation of structural heart disease (SHD) related VT.
Over 10-years, 175 SHD patients underwent VT ablation. Clinical characteristics, and outcomes, were compared between patients undergoing transplant and/or dying and those surviving.
During 2.8 (IQR 1.9-5.0) years follow-up, 37/175 (21%) patients underwent transplant and/or died following VT ablation. Prior to ablation, these patients were older (70.3 ± 11.1 vs. 62.1 ± 13.9 years, P = 0.001), had lower left ventricular ejection fraction ([LVEF] 30 ± 12% vs. 44 ± 14%, P < 0.001), and were more likely to have failed amiodarone (57% vs. 39%, P = 0.050), compared to those that survived. Predictors of transplant and/or mortality included LVEF≤35% (HR 4.71 [95% CI 2.18-10.18], P < 0.001), age ≥ 65 years (HR 2.18 [95% CI 1.01-4.73], P = 0.047), renal impairment (HR 3.73 [95% CI 1.80-7.74], P < 0.001), amiodarone failure (HR 2.67 [95% CI 1.27-5.63], P = 0.010) and malignancy (HR 3.09 [95% CI 1.03-9.26], P = 0.043). Ventricular arrhythmia free survival at 6-months was lower in the transplant and/or deceased, compared to non-deceased group (62% vs. 78%, P = 0.010), but was not independently associated with transplant and/or mortality. The risk score, MORTALITIES-VA, accurately predicted transplant and/or mortality (AUC: 0.872 [95% CI 0.810-0.934]).
Cardiac transplant and/or mortality after VT ablation occurred in 21% of patients. Independent predictors included LVEF≤35%, age ≥ 65 years, renal impairment, malignancy, and amiodarone failure. The MORTALITIES-VA score may identify patients at high-risk of transplant and/or dying after VT ablation.
目前有关导管消融治疗室性心动过速（VT）后死亡率的数据较少。
本研究旨在描述结构性心脏病（SHD）相关 VT 导管消融后心脏移植和/或死亡的原因和预测因素。
在超过 10 年的时间里，175 例 SHD 患者接受了 VT 消融。比较了行移植和/或死亡患者与存活患者的临床特征和结局。
在 2.8（IQR 1.9-5.0）年的随访期间，175 例患者中有 37 例（21%）在 VT 消融后进行了移植和/或死亡。在消融前，这些患者年龄更大（70.3±11.1 岁 vs. 62.1±13.9 岁，P=0.001），左心室射血分数（LVEF）更低（30±12% vs. 44±14%，P<0.001），并且更可能胺碘酮治疗失败（57% vs. 39%，P=0.050）。移植和/或死亡的预测因素包括 LVEF≤35%（HR 4.71 [95% CI 2.18-10.18]，P<0.001）、年龄≥65 岁（HR 2.18 [95% CI 1.01-4.73]，P=0.047）、肾功能不全（HR 3.73 [95% CI 1.80-7.74]，P<0.001）、胺碘酮治疗失败（HR 2.67 [95% CI 1.27-5.63]，P=0.010）和恶性肿瘤（HR 3.09 [95% CI 1.03-9.26]，P=0.043）。与非死亡组相比，移植和/或死亡组的 6 个月时无 VT 心律失常生存较低（62% vs. 78%，P=0.010），但与移植和/或死亡无独立相关性。风险评分 MORTALITIES-VA 准确预测了移植和/或死亡率（AUC：0.872 [95% CI 0.810-0.934]）。
VT 消融后，21%的患者进行了心脏移植和/或死亡。独立预测因素包括 LVEF≤35%、年龄≥65 岁、肾功能不全、恶性肿瘤和胺碘酮治疗失败。MORTALITIES-VA 评分可能识别出 VT 消融后心脏移植和/或死亡风险较高的患者。
