Safety of immediate catheter ablation of ventricular arrhythmias in patients admitted via the emergency department.

BACKGROUND

In patients with ventricular arrhythmias (VA) admitted via the emergency department (ED), immediate catheter ablation (CA-VA) might be indicated to stabilize patients. However, the unstable condition of these patients may increase periprocedural risk. This study evaluated the periprocedural safety of immediate CA-VA in patients admitted via the ED.

METHODS AND RESULTS

In total, 223 ED patients who underwent immediate CA-VA from 01/2017 to 12/2022 (mean age 66 ± 13 years, 19% female, 55% heart failure, 59% coronary artery disease) were analyzed in terms of in-hospital outcomes (periprocedural death, pericardial tamponade, thromboembolic events, major bleedings). To address differences to elective patients, ED patients were compared with 784 elective CA-VA patients (mean age 59 ± 15 years, 34% female, 20% heart failure, 33% coronary artery disease, all p < 0.001): ED patients experienced higher rates of periprocedural complications (6.3% vs. 2.0%, p = 0.002) driven by thromboembolic events (2.2% vs. 0.4%, p = 0.02). Life-threatening complications were not different between groups (cardiac tamponade: 2.2% vs. 1.4%, p = 0.56; stroke: 0.9% vs. 0.4%, p = 0.67). Seven ED patients (3.1%) died unrelated to the procedure during hospitalization vs. none in the elective CA-VA group. Emergency admission (OR 3.07, 95% CI 1.48-6.38), age (OR 2.12, 95% CI 1.22-3.70), and heart failure (OR 1.99, 95% CI 0.96-4.15) were independently associated with periprocedural complications and overall death during hospitalization.

CONCLUSION

Patients with VA admitted via the ED were older, sicker, and more often presented with ventricular tachycardia than elective CA-VA patients. Immediate CA-VA was associated with higher rates of periprocedural complications, driven by thromboembolic events; however, no procedure-related death occurred.