Periprocedural Outcomes of VT Ablation in Ischemic Compared to Non-Ischemic Dilated Cardiomyopathy
Sanchit Duhan1, Shafaqat Ali2, Thannon Alsaeed2
1Department of Cardiology, Carle Foundation Hospital, University of Illinois Urbana-Champaign, Champaign, Illinois, USA.
Insights
Catheter ablation for ventricular tachycardia (VT) in ischemic cardiomyopathy (ICM) patients leads to more non-fatal events. Non-ischemic dilated cardiomyopathy (NIDCM) patients experience higher readmission rates after VT ablation.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Catheter ablation (CA) for ventricular tachycardia (VT) in structural heart disease is linked to adverse events.
- Outcomes of CA for VT differ across cardiomyopathies, necessitating further study.
Purpose of the Study:
- Compare short-term outcomes of CA for VT between ischemic cardiomyopathy (ICM) and non-ischemic dilated cardiomyopathy (NIDCM).
Main Methods:
- Utilized the National Readmission Database (2016-2020) for VT ablation hospitalizations.
- Stratified cohorts by cardiomyopathy and employed Propensity Score Matching (PSM) for comparison.
- Analyzed outcomes using Pearson's Chi-squared test.
Main Results:
- ICM patients had higher rates of sudden cardiac arrest (SCA), major adverse cardiac events, and cardiogenic shock post-ablation.
- NIDCM patients experienced significantly more pericardial complications.
- NIDCM patients demonstrated higher 30, 90, and 180-day readmission rates; mortality differences were not significant.
Conclusions:
- VT ablation in ICM is associated with increased non-fatal periprocedural complications.
- NIDCM patients face higher rates of all-cause readmissions following VT ablation.
Background:
Patients with structural heart disease undergoing catheter ablation (CA) for VT have shown higher procedural-related adverse events. However, periprocedural outcomes comparing CA for VT in different cardiomyopathies are not well known. We aim to study short-term outcomes of CA in ischemic (ICM) compared to non-ischemic dilated cardiomyopathy (NIDCM).
Methods:
The national readmission database (2016-2020) was used to identify hospitalizations for CA for VT. Cohorts were stratified based on underlying cardiomyopathy. A Propensity Score Matching (PSM) model matched ICM to NIDCM patients. Pearson's Chi-squared test was applied to PSM-matched cohorts to compare outcomes.
Results:
Among 7081 hospitalizations for VT ablation, 17.5% of patients had underlying NIDCM, while 82.5% of patients had ICM. On a PSM analysis (N: 3534), ICM patients had higher incidences of sudden cardiac arrest (SCA) (7.9% vs. 5.6%, p < 0.001), major adverse cardiac events (11.1% vs. 9%, p: 0.006), and cardiogenic shock (10.8% vs. 8.5%, p: 0.001). Interestingly, NIDCM patients were found to have much higher rates of pericardial complications (6.09% vs. 1.90%, p < 0.001), while the mortality difference was not significant (p > 0.05). From 2016 to 2020, in-hospital mortality rates have not changed significantly in ICM and NIDCM cases admitted for VT ablation (p-trend > 0.05); however, there was a decreasing trend of SCA cases in NIDCM hospitalizations (8.7%-3.4%, p-trend: 0.028). NIDCM patients had higher readmission rates at 30 days (18% vs. 15.5%, p: 0.01), 90-day (32.3% vs. 29.6%, p: 0.041), and 180-day (44% vs. 38.2%, p: 0.001).
Conclusion:
VT ablation in ICM patients was associated with higher non-fatal periprocedural events. NIDCM patients showed higher all-cause readmission rates.
More Related Videos
12:45Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
10:46Non-fluoroscopic Catheter Tracking for Fluoroscopy Reduction in Interventional Electrophysiology
Published on: May 26, 2015
Related Concept Videos
01:29Cardiomyopathy V: Interprofessional Care
01:30Cardiomyopathy II: Dilated Cardiomyopathy