title: Right heart function prediction of outcome in heart failure patients after catheter ablation for recurrent ventricular tachycardia.
abstract: OBJECTIVE
  This study sought to determine the relevance of echocardiographic assessment focusing on right ventricular (RV) function to estimate prognosis in patients with heart failure (HF) and low left ventricular ejection fraction (LVEF) after ablation of ventricular tachycardia (VT).
  
  
  BACKGROUND
  Recurrent VT is a marker of increased mortality in HF. Decision making remains challenging as some patients have a poor outcome despite successful catheter ablation of VT due to progressive biventricular HF.
  
  
  METHODS
  Retrospective analysis was performed on data from 320 consecutive patients with HF and LVEF ≤40% who underwent ablation for recurrent VT between 1999 and 2008. Baseline clinical and echocardiographic data were analyzed in relation to survival.
  
  
  RESULTS
  Among the 320 patients included, the mean age was 63 years, and 86% were male. During follow-up (median: 36 months) 127 patients (40%) died. RV dysfunction (hazard ratio [HR]: 1.4) and tricuspid regurgitation (TR) (HR: 1.7), together with age, New York Heart Association (NYHA) class, and serum creatinine, were independent predictors of death in a Cox regression model. Mortality was more than 2-fold higher in patients with at least moderate RV dysfunction and TR (HR: 2.6; p < 0.001). In patients with at least moderate RV dysfunction, TR, and estimated pulmonary arterial pressure ≥45 mm Hg, mortality was 61% at 2 years, compared with 16% in patients with good RV function without pulmonary hypertension (p < 0.0001).
  
  
  CONCLUSIONS
  Despite low LVEF, patients with recurrent VT who had good RV function without elevated pulmonary pressures had a good prognosis after VT ablation. RV dysfunction, TR, and elevated pulmonary pressures identified a high-risk group of VT survivors in whom additional interventions may be necessary to improve survival.
authors.affiliation: Cardiovascular Division and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Amaar
authors.initials: A
authors.lastname: Ujeyl
authors.affiliation: Cardiovascular Division and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Inada
authors.affiliation: Department of Economics, University of Hamburg, Hamburg, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Hillmann
authors.affiliation: ProResearch, Asklepios Klinik Hamburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Wohlmuth
authors.affiliation: Cardiovascular Division and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Mahoto
authors.initials: M
authors.lastname: Kato
authors.affiliation: Cardiovascular Division and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Usha
authors.initials: U
authors.lastname: Tedrow
authors.affiliation: Cardiovascular Division and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: lstevenson@partners.com.
authors.forename: Lynne W
authors.initials: LW
authors.lastname: Stevenson
authors.affiliation: Cardiovascular Division and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: William G
authors.initials: WG
authors.lastname: Stevenson
mesh_terms: D017115:Catheter Ablation; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000601:surgery*; D014463:Ultrasonography; D016278:Ventricular Function, Right
keywords: ablation; heart failure; right ventricular function; ventricular tachycardia