Ventricular Tachycardia Ablation in the Elderly: An International Ventricular Tachycardia Center Collaborative Group
Kairav Vakil1, Santiago Garcia2, Roderick Tung2
1From the Section of Cardiology, Minneapolis VA Health Care System, University of Minnesota (K.V., S.G., V.N.T.); Department of Cardiology, University of Colorado, Aurora (W.S.T., W.H.S.); Division of Cardiology, University of Chicago Medical Center, IL (R.T.); UCLA Cardiac Arrhythmia Center, Division of Cardiology, UCLA Health System (M.V., K.S.); Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (D.S.F., D.C., F.M.); Division of Cardiology, Hospital San Raffaele, Milan, Italy (P.D.B., P.V.); Division of Cardiology, Texas Cardiac Arrhythmia Institute; Division of Cardiology, St. David's Medical Center, Austin (L.D.B., J.D.B., A.N.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (U.T., W.G.S.); Division of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (K.N., S.N.); Division of Cardiology, University of Maryland Medical Center, Baltimore (T.D.); Division of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (J.P.W., J.B.); and Division of Cardiology, University of Kansas Medical Center, Kansas City (D.L.). vakil012@umn.edu.
Background:
Successful ventricular tachycardia (VT) ablation is associated with improved survival in patients with heart failure. However, the safety and efficacy of VT ablation in the elderly, a population with higher competing nonsudden death risk and comorbidities, have not been well defined.
Methods And Results:
The International Ventricular Tachycardia Center Collaborative Study Group registry of 2061 patients who underwent VT ablation at 12 international centers was analyzed. Kaplan-Meier analysis was used to estimate survival of patients ≥70 years with and without VT recurrence. Of the 2049 patients who met inclusion criteria, 681 (33%) patients were ≥70 years of age (mean age, 75±4 years). Among these, 92% were men, 71% had ischemic VT, and 42% had VT storm at presentation. Mean (±SD) left ventricular ejection fraction was 30±11%. Compared with patients <70 years, patients ≥70 years had higher in-hospital (4.4% versus 2.3%; P=0.01) and 1-year mortality (15% versus 11%; P=0.002) but a similar incidence of VT recurrence at 1 year (26% versus 25%; P=0.74) and time to VT recurrence (280 versus 289 days; P=0.20). Absence of VT recurrence during follow-up was strongly associated with improved survival in patients ≥70 years.
Conclusion:
VT ablation in the elderly is feasible and reasonably safe with a modestly higher in-hospital and 1-year mortality, with similar rates of VT recurrence at 1 year compared with younger patients. Successful VT ablation, that is, lack of VT recurrence, is strongly associated with improved survival even in this elderly subgroup.
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