PhD Scientific Days 2022

Budapest, 6-7 July 2022

Clinical Medicine II.

Comparing Predictors of Arrhythmia Recurrence and Repeat Ventricular Tachycardia Ablation in Patients with Structural Heart Disease

Ferenc Komlósi M.D.1, Patrik Tóth M.D.1, Péter Vámosi M.D.1, Sámuel Beke1, Nándor Szegedi M.D., Ph.D.1, Zoltán Salló M.D.1, Katalin Piros M.D.1, Péter Perge M.D. Ph.D.1, István Osztheimer M.D. Ph.D.1, Pál Ábrahám M.D. Ph.D.1, Béla Merkely M.D., Ph.D., D.Sc.1, László Gellér M.D., Ph.D., D.Sc.1, Klaudia Vivien Nagy M.D., Ph.D.1

1 Semmelweis Heart and Vascular Center

Text of the abstract

Aims
While the predictors of clinically significant ventricular tachycardia (VT) recurrence are widely studied, factors predicting an additional ablation are unknown. We aimed to establish predictors of repeat ablation and compare to the predictors of arrhythmia recurrence during 1-year follow-up in structural heart disease.
Methods
Baseline medical history, laboratory results, imaging parameters, clinical properties of VTs, and procedural data were gathered in a structured database.
Results
Out of the 272 patients, 96 (35%) experienced recurrence and 36 (13%) had repeated procedures within 1 year. Independent predictors of recurrence were left ventricular end systolic diameter (HR = 1.516, p=0.015), severe mitral regurgitation (HR = 2.446, p = 0.002), incessant VT (HR = 1.64, p = 0.02), VT inducibility (HR = 3.71, p = 0.003), ICD shocks (HR = 1.95, p = 0.002) and elevated LDH levels (HR = 1.26, p = 0.003). Regarding redo ablation, elevated LDH level (HR = 1.64, p = 0.01), incessant VT (HR = 2.94, p < 0.001), ICD shocks (HR = 2.38, p = 0.02), only exit point ablation (HR = 2.14, p = 0.023) were independent predictors, while hypertension (HR = 0.32, p = 0.03), longer transmitral E-wave deceleration time (HR = 0.47, p = 0.04), substrate modification (HR = 0.47, p = 0.044) were protective.
Conclusion
According to our findings, the predictors of repeat ablation only partially overlap with those of VT recurrence. Patients presenting with ICD shocks or incessant VT and showing severe left ventricular dilation and more severe MR more probably experience recurrence. Important predictors of a redo procedure are incessant VT, ICD shocks, restrictive diastolic filling pattern and elevated LDH levels.

Funding
Project no. NVKP_16-1–2016-0017 (’National Heart Program’)
Thematic Excellence Programme (2020-4.1.1.-TKP2020) of the Ministry for Innovation and Technology in Hungary