Home > News > 25/Impact of electrical storm and ablation strategy on 5-year outcome of catheter ablation for ventricular tachycardia in patients with ischaemic and non-ischaemic cardiomyopathies
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25/Impact of electrical storm and ablation strategy on 5-year outcome of catheter ablation for ventricular tachycardia in patients with ischaemic and non-ischaemic cardiomyopathies

Published Online: October 3rd 2021 European Journal of Arrhythmia & Electrophysiology. 2021;7(Suppl. 1):abstr25
Authors: SH Man (Presenting Author) - University Hospitals of Leicester NHS Trust, Leicester; JO Ajagu - University Hospitals of Leicester NHS Trust, Leicester; N Chan - University Hospitals of Leicester NHS Trust, Leicester; R Somani - University Hospitals of Leicester NHS Trust, Leicester; PJ Stafford - University Hospitals of Leicester NHS Trust, Leicester; AJ Sandilands - University Hospitals of Leicester NHS Trust, Leicester; M Ibrahim - University Hospitals of Leicester NHS Trust, Leicester; M Lazdam - University Hospitals of Leicester NHS Trust, Leicester; GA Ng - University Hospitals of Leicester NHS Trust, Leicester; SH Chin - University Hospitals of Leicester NHS Trust, Leicester
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Introduction: Patients with structural heart disease (SHD) are susceptible to ventricular tachycardia (VT) and arrhythmic death. Use of anti-arrhythmic drugs is often confounded by unacceptable side effects or suboptimal effectiveness. Catheter ablation (CA) is a viable option in these patients. This study aims to: 1) determine long-term outcome of patients with SHD undergoing CA for VT; and 2) identify potential predictors of favourable ablation outcome and improved survival.

Method: This single-centre longitudinal study enrolled patients with ischaemic (ICM) and non-ischaemic cardiomyopathies (NICM) undergoing CA for VT. Follow-up data on 5-year survival and ICD shocks for VT were collected. Potential demographic, clinical and procedural predictors of VT-free survival were assessed. Cox regression and Kaplan–Meier analyses were performed.

Results: Seventy-six patients (ICM 43%, NICM 57%; male 79%) were included. Electrical storm is more prevalent in the ICM group (ICM 50% vs. NICM 14%). At ablation, unstable clinical VT were more prevalent in ICM group (52% vs. 32%, p<0.05) despite similar VT inducibility. In these patients, only substrate-based ablation was performed. Ablation endpoint was determined by VT non-inducibility (ICM 70% vs. NICM 76%, p=ns). Acute complication rate was 18.4% including vascular complications (5.3%), cardiac tamponade (1.3%), stroke (1.3%), MI (1.3%), cardiogenic shock (2.6%) and death (1.3%). In both groups, there were significant reduction in ICD shocks after CA. However, NICM group demonstrated superior long-term VT-free survival (Figure 1). Independent predictors of mortality include age >60 years, LVEF <35%, electrical storm, declined eGFR and substrate-based ablation strategy. VT non-inducibility as ablation endpoint independently predicts freedom from ICD shocks.

Conclusion: VT ablation significantly reduces ICD shocks for VT but mortality remains high in some patients. VT non-inducibility as ablation endpoint partially prognosticates VT recurrence. Future studies are warranted to refine patient profiling, thereby further optimising long-term VT ablation outcomes.

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43/Cardiac tamponade as a complication of transseptal puncture: associations and operatordependent variables during left atrial ablation at Barts Heart Centre
E Maclean (Presenting Author) - St Bartholomew’s Hospital, London; K Mahtani - St Bartholomew’s Hospital, London; C Butcher - St Bartholomew’s Hospital, London; N Ahluwalia - St Bartholomew’s Hospital, London; M Finlay - St Bartholomew’s Hospital, London; S Honarbakhsh - St Bartholomew’s Hospital, London; A Creta - St Bartholomew’s Hospital, London; A Chow - St Bartholomew’s Hospital, London; V Sawhney - St Bartholomew’s Hospital, London; V Ezzat - St Bartholomew’s Hospital, London; MJ Earley - St Bartholomew’s Hospital, London; M Dhinoja - St Bartholomew’s Hospital, London; S Sporton - St Bartholomew’s Hospital, London; MD Lowe - St Bartholomew’s Hospital, London; PD Lambiase - St Bartholomew’s Hospital, London; F Khan - St Bartholomew’s Hospital, London; SY Ahsan - St Bartholomew’s Hospital, London; RJ Hunter - St Bartholomew’s Hospital, London; RJ Schilling - St Bartholomew’s Hospital, London; O Sega - St Bartholomew’s Hospital, London Read Time: 2 mins

European Journal of Arrhythmia & Electrophysiology. 2021;7(Suppl. 1):abstr43

Introduction: Cardiac tamponade is a high morbidity complication of transseptal puncture (TSP). We examined the incidence and predictors of TSP-related cardiac tamponade (TRCT) for all patients undergoing left atrial ablation at our centre from 2016-2020. Methods: Patient and procedural variables were extracted retrospectively. Cases of cardiac tamponade were scrutinised to adjudicate TSP culpability. Adjusted multivariate […]

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