Background: Ventricular tachycardia (VT) patients frequently present in unstable VT and are subject to urgent/high risk ablation procedures. Clinical predictors of prolonged hospitalization and mortality are needed for optimal management of these patients.

Objective: This study seeks to identify factors associated with prolonged hospitalization and mortality in emergent unplanned VT ablation procedures.

Methods: Fifty consecutive patients hospitalized emergently for VT with structural heart disease who underwent catheter ablation were prospectively followed for outcomes and complications.

Results: Of the 50 patients (mean age 67.6 ± 12.8, 86.0% men, 62.0% ischemic cardiomyopathy, median LVEF 28.5%). Hospital stay <7 days (median 3 days) occurred in 28 (56.0%) patients (Group 1) and ≥7 days (median 10 days) or death <7 days in 22 (44.0%, Group 2). PAINESD score and LVEF were similar between the groups. Compared to Group 1, Group 2 had significantly worse NYHA class ≥3 (25.0% vs. 63.6%, p=0.006), electrical storm (46.4% vs. 77.3%, p=0.027), and prior failed VT ablation (35.7% vs. 68.2%, p=0.023). Multivariable analysis demonstrated NYHA class ≥3 and prior failed VT ablation were predictive of prolonged hospital stay. Following ablation, compared to Group 1, Group 2 had worse heart failure (10.7% vs. 54.5%, p=0.001), VT recurrences (3.6% vs. 68.2%, p<0.001) and 7 deaths within 30 days.

Conclusions: Patients undergoing emergent VT ablation are at high risk for prolonged hospital stay, which is predicted by NYHA class ≥3 and a prior failed ablation. Early VT recurrences and worsening heart failure contribute to prolonged hospitalization and a high 30-day mortality.

Editor-in-Chief
Kalyanam Shivkumar, MD, PhD, FACC
 
CME Editor
Kenneth A. Ellenbogen, MD, FACC

Author
Mahmoud Houmsse, MD, FACC


Important Dates
Date of Release: December 23, 2024
Term of Approval/Date of CME/MOC Expiration: December 23, 2025