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

作者：Santangeli Pasquale; Muser Daniele; Zado Erica S; Magnani Silvia; Khetpal Sumun; Hutchinson Mathew D; Supple Gregory; Frankel David S; Garcia Fermin C; Bala Rupa; Riley Michael P; Lin David; Rame J Eduardo; Schaller Robert; Dixit Sanjay; Marchlinski Francis E; Callans David J^*

来源：Circulation-Arrhythmia and Electrophysiology, 2015, 8(1): 68-75.

DOI：10.1161/CIRCEP.114.002155

• catheter ablation
• mortality
• ventricular tachycardia

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.

• 出版日期2015-2