title: Management of ventricular tachycardia in the setting of a dedicated unit for the treatment of complex ventricular arrhythmias: long-term outcome after ablation.
abstract: BACKGROUND
  We investigated the impact of catheter ablation on ventricular tachycardia (VT) recurrence and survival in a large number of patients with structural heart disease treated in the setting of a dedicated multiskilled unit.
  
  
  RESULTS
  Since January 2007, we have implemented a multidisciplinary model, aiming for a comprehensive management of VT patients. Programmed ventricular stimulation was used to assess acute outcome. Primary end points were VT recurrence and the occurrence of cardiac and sudden cardiac death. Overall, 528 patients were treated by ablation (634 procedures; 1-4 procedures per patient). Among 482 tested with programmed ventricular stimulation after the last procedure, a class A result (noninducibility of any VT) was obtained in 371 patients (77%), class B (inducibility of nondocumented VT) in 12.4%, and class C (inducibility of index VT) in 10.6%. After a median follow-up time of 26 months, VT recurred in 164 (34.1%) of 472 patients. VT recurrence was documented in 28.6% of patients with a class A result versus 39.6% of patients with class B and 66.7% with class C result (log-rank P<0.001). The incidence of cardiac mortality was lower in class A patients than in those with class B and class C (8.4% versus 18.5% versus 22%, respectively; log-rank P=0.002). On the basis of multivariate analysis, postprocedural inducibility of index VT was independently associated both with VT recurrence (hazard ratio, 4.030; P<0.001) and with cardiac mortality (hazard ratio, 2.099; P=0.04).
  
  
  CONCLUSIONS
  Within a dedicated VT unit, catheter ablation prevents long-term VT recurrences, which may favorably affect survival in a large number of patients who have VT.
authors: Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, via Olgettina 60, Milan, Italy. dellabella.paolo@hsr.it
authors: Paolo
authors: P
authors: Della Bella
authors: Francesca
authors: F
authors: Baratto
authors: Dimitris
authors: D
authors: Tsiachris
authors: Nicola
authors: N
authors: Trevisi
authors: Pasquale
authors: P
authors: Vergara
authors: Caterina
authors: C
authors: Bisceglia
authors: Francesco
authors: F
authors: Petracca
authors: Corrado
authors: C
authors: Carbucicchio
authors: Stefano
authors: S
authors: Benussi
authors: Francesco
authors: F
authors: Maisano
authors: Ottavio
authors: O
authors: Alfieri
authors: Federico
authors: F
authors: Pappalardo
authors: Alberto
authors: A
authors: Zangrillo
authors: Giuseppe
authors: G
authors: Maccabelli
mesh_terms: D000368:Aged; D017115:Catheter Ablation / Q000379:methods / Q000401:mortality / Q000639:trends*; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006757:Hospital Units / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000639:trends*; D011446:Prospective Studies; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome