Abstract:

Background: The PAINESD risk score has been validated as a predictor of periprocedural acute hemodynamic decompensation (AHD) in patients undergoing ventricular tachycardia (VT) ablation. Whether the addition of total scar volume (TSV) determined by pre-procedure CT imaging provides additional risk stratification has not been previously investigated.

Objectives: The purpose of this study was to evaluate the impact of TSV on risk of AHD and its adjunctive benefit to the PAINESD score newly modified as PAINES2D based upon addition of scar volumes.

Methods: This was a retrospective analysis of all index VT ablations at a quaternary care center from 2017-2022. Associations between TSV and AHD were evaluated in patients with structural heart disease.

Results: Among 61 patients with TSV data, 13 (21%) had periprocedural AHD. TSV and PAINESD were independently associated with AHD risk. Both TSV and PAINESD were associated with AHD (p = 0.016 vs p = 0.053, respectively). Highest TSV tertile (>37.30mL) showed significant association with AHD (p = 0.018, OR = 4.80) compared to those in other tertiles. PAINESD and PAINES2D scores had significant impact on AHD (p = 0.046 and p = 0.010, respectively). PAINES2D score had greater impact on AHD compared to PAINESD (AUC = 0.73, p = 0.011, CI 0.56-0.91 and AUC = 0.67, p = 0.058, CI 0.49-0.85, respectively).

Conclusions: Addition of TSV to a modified PAINESD, PAINES2D, enhances risk prediction of AHD, but further prospective study is needed to assess benefit in various cardiomyopathy populations undergoing VT ablation.​

Editor-in-Chief

Kalyanam Shivkumar, MD, PhD, FACC 

CME Editor
Kenneth A. Ellenbogen, MD, FACC

Author
Kelvin Bush, MD, FACC

Important Dates
Date of Release: August 28, 2023
Term of Approval/Date of CME/MOC Expiration: August 27, 2024