Ventricular Tachycardia Ablation Outcomes in Patients Without Previous Implantable Cardioverter-Defibrillator
Ali Saad Al-Shammari1,2, Ankur Singla3, Ameer Awashra4
1Department of Internal Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq.
Insights
Catheter ablation significantly lowers in-hospital mortality and major adverse cardiac events for ventricular tachycardia (VT) patients without an implantable cardioverter-defibrillator (ICD). While associated with increased procedural risks like tamponade, ablation improves survival outcomes in this high-risk group.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Ventricular tachycardia (VT) is a life-threatening arrhythmia.
- Implantable cardioverter-defibrillators (ICDs) are standard management, but many patients lack them.
- The benefit of catheter ablation in ICD-naive VT patients requires further investigation.
Purpose of the Study:
- To assess the association between catheter ablation and short-term in-hospital outcomes in patients with VT who have not received an ICD.
- To evaluate the safety and efficacy of catheter ablation as a treatment option for this specific patient population.
Main Methods:
- Retrospective analysis of the National Inpatient Sample (2016-2021) for adult VT hospitalizations.
- Exclusion of patients with prior ICDs or during-admission ICD implantation.
- Comparison of outcomes between patients undergoing catheter ablation versus those not, using propensity score matching (PSM).
Main Results:
- Catheter ablation was linked to reduced in-hospital mortality (3.17% vs. 8.98%), STEMI (6.82% vs. 18.83%), sepsis (3.38% vs. 10.34%), and MACEs (15.82% vs. 28.40%) after PSM.
- Ablation was associated with increased rates of cardiac tamponade (1.78% vs. 0.43%), cardiogenic shock (9.14% vs. 7.12%), and mechanical circulatory support (MCS) use (5.04% vs. 3.71%).
- No significant difference was observed in acute heart failure or prolonged hospitalization rates.
Conclusions:
- Catheter ablation demonstrates improved in-hospital survival and reduced major complications for ICD-naive VT patients.
- The procedure carries higher risks, including tamponade and need for MCS.
- Catheter ablation represents a viable option for selected ICD-naive VT patients, balancing survival benefits against procedural risks.
Abstract:
Ventricular tachycardia (VT) is a fatal arrhythmia, often managed with implantable cardioverter-defibrillators (ICDs). Many patients, however, present without an ICD. The role of catheter ablation in this high-risk group is unclear, particularly for short-term in-hospital outcomes. We assessed associations between ablation and in-hospital outcomes among ICD-naive VT patients using a large national dataset. We conducted a retrospective study using the National Inpatient Sample (2016-2021), identifying adult hospitalizations with VT. Patients with prior ICDs or ICD implantation during the same admission were excluded. The cohort was divided into those who underwent catheter ablation versus those managed without ablation. Multivariable logistic regression and 1:1 propensity score matching (PSM) adjusted for demographic, clinical, and hospital factors. The primary outcome was in-hospital mortality; secondary outcomes included ST-elevation myocardial infarction (STEMI), sepsis, major adverse cardiac events (MACEs) (death, STEMI, or cardiogenic shock), cardiogenic shock, tamponade, mechanical circulatory support (MCS), acute heart failure, and prolonged hospitalization (≥7 days). Of 2,214,424 VT hospitalizations, 32,640 (1.5%) underwent catheter ablation. After PSM (n = 12,668), ablation was associated with significantly lower rates of in-hospital mortality (3.17% vs. 8.98%; P < .001), STEMI (6.82% vs. 18.83%; P < .001), sepsis (3.38% vs. 10.34%; P < .001), and MACEs (15.82% vs. 28.40%; P < .001). However, ablation was associated with higher rates of cardiac tamponade (1.78% vs. 0.43%; P < .001), cardiogenic shock (9.14% vs. 7.12%; P < .001), and MCS use (5.04% vs. 3.71%; P < .001). Rates of acute heart failure and prolonged hospitalization were comparable. In ICD-naive VT patients, catheter ablation was associated with improved in-hospital survival and fewer complications, albeit with higher procedural risks.
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