title: Ventricular Tachycardia Ablation in Severe Heart Failure: An International Ventricular Tachycardia Ablation Center Collaboration Analysis.
abstract: Ventricular tachycardia (VT) radiofrequency ablation has been associated with reduced VT recurrence and mortality, although it is typically not considered among New York Heart Association class IV (NYHA IV) heart failure patients. We compared characteristics and VT radiofrequency ablation outcomes of those with and without NYHA IV in the International VT Ablation Center Collaboration.
  
  
  
  NYHA II-IV patients undergoing VT radiofrequency ablation at 12 international centers were included. Clinical variables, VT recurrence, and mortality were analyzed by NYHA IV status using Kaplan-Meier analysis and Cox proportional hazard models. There were significant differences between NYHA IV (n=111) and NYHA II and III (n=1254) patients: NYHA IV had lower left ventricular ejection fraction; more had diabetes mellitus, kidney disease, cardiac resynchronization implantable cardioverter-defibrillator, and VT storm despite greater antiarrhythmic drug use (P<0.01). NYHA IV subjects required more hemodynamic support, were inducible for more and slower VTs, and were less likely to undergo final programmed stimulation. There was no significant difference in acute complications. In-hospital deaths, recurrent VT, and 1-year mortality were higher in the NYHA IV group, in the context of greater baseline comorbidities. Importantly, NYHA IV patients without recurrent VT had similar survival compared with NYHA II and III patients with recurrent VT (68% versus 73%). Early VT recurrence (≤30 days) was significantly associated with mortality, especially in NYHA IV patients.
  
  
  
  Despite greater baseline comorbidities, VT radiofrequency ablation can be safely performed among NYHA IV patients. Early VT recurrence is significantly associated with subsequent mortality regardless of NYHA status. Elimination of recurrent VT in NYHA IV patients may reduce mortality to a level comparable to NYHA II and III with arrhythmia recurrence.
authors.affiliation: For the author affiliations, please see the Appendix. wendy.tzou@ucdenver.edu.
authors.forename: Wendy S
authors.initials: WS
authors.lastname: Tzou
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: Roderick
authors.initials: R
authors.lastname: Tung
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: David S
authors.initials: DS
authors.lastname: Frankel
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: Marmar
authors.initials: M
authors.lastname: Vaseghi
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: T Jared
authors.initials: TJ
authors.lastname: Bunch
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: Venkatakrishna N
authors.initials: VN
authors.lastname: Tholakanahalli
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: Timm
authors.initials: T
authors.lastname: Dickfeld
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: Anastasios
authors.initials: A
authors.lastname: Saliaris
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: J Peter
authors.initials: JP
authors.lastname: Weiss
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: Nilesh
authors.initials: N
authors.lastname: Mathuria
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: Usha
authors.initials: U
authors.lastname: Tedrow
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: Mohammed R
authors.initials: MR
authors.lastname: Afzal
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Vergara
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: Koichi
authors.initials: K
authors.lastname: Nagashima
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: Mehul
authors.initials: M
authors.lastname: Patel
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: Shiro
authors.initials: S
authors.lastname: Nakahara
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: Kairav
authors.initials: K
authors.lastname: Vakil
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: J David
authors.initials: JD
authors.lastname: Burkhardt
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: Chi-Hong
authors.initials: CH
authors.lastname: Tseng
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: Kalyanam
authors.initials: K
authors.lastname: Shivkumar
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: David J
authors.initials: DJ
authors.lastname: Callans
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: William G
authors.initials: WG
authors.lastname: Stevenson
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: Paolo
authors.initials: P
authors.lastname: Della Bella
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
authors.affiliation: For the author affiliations, please see the Appendix.
authors.forename: William H
authors.initials: WH
authors.lastname: Sauer
mesh_terms: D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome
keywords: catheter ablation; heart failure; tachycardia, ventricular