Background-The occurrence of periprocedural acute hemodynamic decompensation (AHD) in patients undergoing radiofrequency catheter ablation of scar-related ventricular tachycardia (VT) has not been previously investigated. Methods and Results-We identified univariate predictors of periprocedural AHD in 193 consecutive patients undergoing radiofrequency catheter ablation of scar-related VT. AHD was defined as persistent hypotension despite vasopressors and requiring mechanical support or procedure discontinuation. AHD occurred in 22 (11%) patients. Compared with he rest of the population, patients with AHD were older (68.5 +/- 10.7 versus 61.6 +/- 15.0 years; P = 0.037); had a higher prevalence of diabetes mellitus (36% versus 18%; P = 0.045), ischemic cardiomyopathy (86% versus 52%; P = 0.002), chronic obstructive pulmonary disease (41% versus 13%; P = 0.001), and VT storm (77% versus 43%; P = 0.002); had more severe heart failure (New York Heart Association class III/IV: 55% versus 15%, P < 0.001; left ventricular ejection fraction: 26 +/- 10% versus 36 +/- 16%, P = 0.003); and more often received periprocedural general anesthesia (59% versus 29%; P = 0.004). At 21 +/- 7 months follow-up, the mortality rate was higher in the AHD group compared with the rest of the population (50% versus 11%, log-rank P < 0.001). Conclusions-AHD occurs in 11% of patients undergoing radiofrequency catheter ablation of scar-related VT and is associated with increased risk of mortality over follow-up. AHD may be predicted by clinical factors, including advanced age, ischemic cardiomyopathy, more severe heart failure status (New York Heart Association class III/IV, lower ejection fraction), associated comorbidities (diabetes mellitus and chronic obstructive pulmonary disease), presentation with VT storm, and use of general anesthesia.

Acute Hemodynamic Decompensation During Catheter Ablation of Scar-Related Ventricular Tachycardia Incidence, Predictors, and Impact on Mortality

Muser D;
2015-01-01

Abstract

Background-The occurrence of periprocedural acute hemodynamic decompensation (AHD) in patients undergoing radiofrequency catheter ablation of scar-related ventricular tachycardia (VT) has not been previously investigated. Methods and Results-We identified univariate predictors of periprocedural AHD in 193 consecutive patients undergoing radiofrequency catheter ablation of scar-related VT. AHD was defined as persistent hypotension despite vasopressors and requiring mechanical support or procedure discontinuation. AHD occurred in 22 (11%) patients. Compared with he rest of the population, patients with AHD were older (68.5 +/- 10.7 versus 61.6 +/- 15.0 years; P = 0.037); had a higher prevalence of diabetes mellitus (36% versus 18%; P = 0.045), ischemic cardiomyopathy (86% versus 52%; P = 0.002), chronic obstructive pulmonary disease (41% versus 13%; P = 0.001), and VT storm (77% versus 43%; P = 0.002); had more severe heart failure (New York Heart Association class III/IV: 55% versus 15%, P < 0.001; left ventricular ejection fraction: 26 +/- 10% versus 36 +/- 16%, P = 0.003); and more often received periprocedural general anesthesia (59% versus 29%; P = 0.004). At 21 +/- 7 months follow-up, the mortality rate was higher in the AHD group compared with the rest of the population (50% versus 11%, log-rank P < 0.001). Conclusions-AHD occurs in 11% of patients undergoing radiofrequency catheter ablation of scar-related VT and is associated with increased risk of mortality over follow-up. AHD may be predicted by clinical factors, including advanced age, ischemic cardiomyopathy, more severe heart failure status (New York Heart Association class III/IV, lower ejection fraction), associated comorbidities (diabetes mellitus and chronic obstructive pulmonary disease), presentation with VT storm, and use of general anesthesia.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11699/83221
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