title: Acute failure of catheter ablation for ventricular tachycardia due to structural heart disease: causes and significance.
abstract: BACKGROUND
  Acute end points of catheter ablation for ventricular tachycardia (VT) remain incompletely defined. The aim of this study is to identify causes for failure in patients with structural heart disease and to assess the relation of this acute outcome to longer-term management and outcomes.
  
  
  RESULTS
  From 2002 to 2010, 518 consecutive patients (84% male, 62 ± 14 years) with structural heart disease underwent a first ablation procedure for sustained VT at our institution. Acute ablation failure was defined as persistent inducibility of a clinical VT. Acute ablation failure was seen in 52 (10%) patients. Causes for failure were: intramural free wall VT in 13 (25%), deep septal VT in 9 (17%), decision not to ablate due to proximity to the bundle of His, left phrenic nerve, or a coronary artery in 3 (6%), and endocardial ablation failure with inability or decision not to attempt to access the epicardium in 27 (52%) patients. In multivariable analysis, ablation failure was an independent predictor of mortality (hazard ratio 2.010, 95% CI 1.147 to 3.239, P=0.004) and VT recurrence (hazard ratio 2.385, 95% CI 1.642 to 3.466, P<0.001).
  
  
  CONCLUSIONS
  With endocardial or epicardial ablation, or both, acute ablation failure was seen in 10% of patients, largely due to anatomic factors. Persistence of a clinical VT is associated with recurrence and comparatively higher mortality.
authors.affiliation: Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA. tokudam@gmail.com
authors.forename: Michifumi
authors.initials: M
authors.lastname: Tokuda
authors.forename: Pipin
authors.initials: P
authors.lastname: Kojodjojo
authors.forename: Stanley
authors.initials: S
authors.lastname: Tung
authors.forename: Usha B
authors.initials: UB
authors.lastname: Tedrow
authors.forename: Eyal
authors.initials: E
authors.lastname: Nof
authors.forename: Keiichi
authors.initials: K
authors.lastname: Inada
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Koplan
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Michaud
authors.forename: Roy M
authors.initials: RM
authors.lastname: John
authors.forename: Laurence M
authors.initials: LM
authors.lastname: Epstein
authors.forename: William G
authors.initials: WG
authors.lastname: Stevenson
mesh_terms: D017115:Catheter Ablation; D005260:Female; D006331:Heart Diseases / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000150:complications* / Q000601:surgery*; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: catheter ablation; failure; outcome; structural heart disease; ventricular tachycardia