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Arrhythmias and sudden death
Original research
Long-term follow-up of normal and structural heart ventricular tachycardia catheter ablation: real-world experience from a UK tertiary centre
  1. Ahmed M Adlan1,2,
  2. Aruna Arujuna2,
  3. Rory Dowd2,3,
  4. Sajad Hayat2,
  5. Sandeep Panikker2,
  6. Will Foster2,4,
  7. Shamil Yusuf2,3,
  8. Fraz Umar5,
  9. Nicolas Lellouche6,
  10. Faizel Osman7,8 and
  11. Tarvinder Dhanjal2
  1. 1Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
  2. 2Department of Cardiology, University Hospital Coventry, Coventry, UK
  3. 3Department of Cardiology, Good Hope Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  4. 4Department of Cardiology, Worcestershire Royal Hospital, Worcester, UK
  5. 5University Hospital Coventry, Coventry, UK
  6. 6Hopital Henri Mondor, Paris, Île-de-France, France
  7. 7Cardiology, University Hospital Coventry, Coventry, UK
  8. 8Warwick Medical School, University of Warwick, Coventry, UK
  1. Correspondence to Dr Tarvinder Dhanjal; tarv.dhanjal{at}uhcw.nhs.uk

Abstract

Background Ventricular tachycardia (VT) is associated with increased morbidity and mortality. There is growing evidence for the effectiveness of catheter ablation in improving outcomes in patients with recurrent VT. Consequently the threshold for referral for VT ablation has fallen over recent years, resulting in increased number of procedures.

Objective To evaluate the effectiveness and safety of VT ablation in a real-world tertiary centre setting.

Methods This is a prospective analysis of all VT ablation cases performed at University Hospital Coventry. Follow-up data were obtained from review of electronic medical records and patient interview. The primary endpoint for normal heart VT was death, cardiovascular hospitalisation and VT recurrence, and for structural heart VT was arrhythmic death, VT storm (>3 episodes within 24 hours) or appropriate shock.

Results Forty-seven patients underwent 53 procedures from January 2012 to January 2018. The mean age ±SD was 57±15 years, 68% were male, 81% were Caucasian and 66% were elective cases. The aetiology of VT included normal heart (49%), ischaemic cardiomyopathy (ICM, 36%), dilated cardiomyopathy (9%), hypertrophic cardiomyopathy (4%) and valvular heart disease (2%). Procedural success occurred in 83%, with six major complications. After a median follow-up of 231 days (lower quartile 133, upper quartile 631), the primary outcome occurred in 28% of patients. There were two non-arrhythmic deaths (4%). At a median follow-up of 193 days (129–468), the primary outcome occurred in 19% of patients with ICM, while VT storm/appropriate shocks occurred in three patients (17%).

Conclusions Our real-world registry confirms that VT ablation is safe, and is associated with high acute procedural success and long-term outcomes comparable with randomised controlled studies.

  • Ventricular tachycardia
  • catheter ablation
  • ischaemic cardiomyopathy

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/openhrt-2018-000996

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    Footnotes

    • Twitter @ahmed_adlan

    • Contributors TD and FO designed the study. TD, AMA, AA and RD collected the data. TD, FO, SH, SP, WF and SY recruited the patients and performed the procedures. AMA performed the statistical analysis and drafted the manuscript. All authors performed the critical review of the manuscript, including multiple drafts, and approved the final version.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study applied the principles of the Declaration of Helsinki, with ethical approval obtained from our local audit and research department.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.