title: Acute hemodynamic decompensation during catheter ablation of scar-related ventricular tachycardia: incidence, predictors, and impact on mortality.
abstract: BACKGROUND
  The occurrence of periprocedural acute hemodynamic decompensation (AHD) in patients undergoing radiofrequency catheter ablation of scar-related ventricular tachycardia (VT) has not been previously investigated.
  
  
  RESULTS
  We identified univariate predictors of periprocedural AHD in 193 consecutive patients undergoing radiofrequency catheter ablation of scar-related VT. AHD was defined as persistent hypotension despite vasopressors and requiring mechanical support or procedure discontinuation. AHD occurred in 22 (11%) patients. Compared with the rest of the population, patients with AHD were older (68.5±10.7 versus 61.6±15.0 years; P=0.037); had a higher prevalence of diabetes mellitus (36% versus 18%; P=0.045), ischemic cardiomyopathy (86% versus 52%; P=0.002), chronic obstructive pulmonary disease (41% versus 13%; P=0.001), and VT storm (77% versus 43%; P=0.002); had more severe heart failure (New York Heart Association class III/IV: 55% versus 15%, P<0.001; left ventricular ejection fraction: 26±10% versus 36±16%, P=0.003); and more often received periprocedural general anesthesia (59% versus 29%; P=0.004). At 21±7 months follow-up, the mortality rate was higher in the AHD group compared with the rest of the population (50% versus 11%, log-rank P<0.001).
  
  
  CONCLUSIONS
  AHD occurs in 11% of patients undergoing radiofrequency catheter ablation of scar-related VT and is associated with increased risk of mortality over follow-up. AHD may be predicted by clinical factors, including advanced age, ischemic cardiomyopathy, more severe heart failure status (New York Heart Association class III/IV, lower ejection fraction), associated comorbidities (diabetes mellitus and chronic obstructive pulmonary disease), presentation with VT storm, and use of general anesthesia.
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Daniele
authors.initials: D
authors.lastname: Muser
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Erica S
authors.initials: ES
authors.lastname: Zado
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Silvia
authors.initials: S
authors.lastname: Magnani
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Sumun
authors.initials: S
authors.lastname: Khetpal
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Mathew D
authors.initials: MD
authors.lastname: Hutchinson
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Supple
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: David S
authors.initials: DS
authors.lastname: Frankel
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Fermin C
authors.initials: FC
authors.lastname: Garcia
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Rupa
authors.initials: R
authors.lastname: Bala
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Riley
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: David
authors.initials: D
authors.lastname: Lin
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: J Eduardo
authors.initials: JE
authors.lastname: Rame
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Robert
authors.initials: R
authors.lastname: Schaller
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dixit
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA. david.callans@uphs.upenn.edu.
authors.forename: David J
authors.initials: DJ
authors.lastname: Callans
mesh_terms: D000367:Age Factors; D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects; D001794:Blood Pressure; D017115:Catheter Ablation / Q000009:adverse effects* / Q000401:mortality; D002921:Cicatrix / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D015897:Comorbidity; D005260:Female; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: catheter ablation; mortality; ventricular tachycardia