PhD Scientific Days 2022

Clinical Medicine II.

Gender differences in factors predicting ablation success and 1-year mortality in ventricular tachycardia patients with structural heart disease

Text of the abstract

Introduction
The incidence of ventricular tachycardias (VT) in women is known to be significantly lower compared to men and clinical studies assessing the predictors of VT ablation success tend to underrepresent the female population.
Aims
We aimed to identify gender specific predictors of 1-year VT recurrence and 1-year mortality after catheter ablation in patients with structural heart disease.
Method
Between January 2005 and December 2020, 284 patients underwent VT ablation with structural heart disease and sustained monomorphic VT. Medical history, laboratory results, imaging parameters, clinical properties of VTs, and procedural data were gathered in a structured database. The patients were followed up for one year after ablation, data on VT recurrence and all-cause mortality was collected.
Results
Out of the 284 patients, 33 (11,6%) were female. 13 (39,4%) of the women and 107 (43,1%) of the men experienced recurrence; one year mortality was 11 (35,5%) and 48 (19,8%) in women and men, respectively. Creatine-kinase was the only independent predictor of recurrence (p=0,03). In the male population implanted cardiac resynchronization therapy device (p=0,004) and elevated lactate-dehydrogenase (p<0,001) were significant with multivariate analysis. Regarding the 1-year mortality, use of angiotensin-convertase enzyme inhibitor/angiotensin receptor blocker and elevated sodium levels were associated with better outcomes with both uni- (p=0,008, p=0,02) and multivariate analysis (p=0,04, p=0,047). Older age (p=0,01) and electrical storm (p=0,049) were the independent predictors among men. Higher left ventricular ejection fraction (p=0,04) and longer mitral E-wave deceleration time (p=0,001) were associated with reduced mortality.
Conclusion
Predictors of VT ablation success and mortality show marked gender differences. Factors associated with ischemic events and consecutive heart failure are the main predictors among men, while untreated heart failure led to a worse outcome in the observed endpoints among women.
E-mail: patrik.toth96@gmail.com
Semmelweis University, Doctoral School of Theoretical and Translational Medicine
Supervisor: Klaudia Vivien Nagy, MD, PhD