10 years all cause Mortality Risk high after VT ablation more so in patients with structural heart disease: Study

A decade-long study which is a part of the German Ablation Registry highlighted the long-term outcomes of catheter ablation, the primary treatment for idiopathic ventricular tachycardia (VT). The findings of this study were published in the Journal of the American Heart Association. 

The research encompassed data from 334 patients and the findings show the significant differences in survival rates between those with structurally normal hearts and those with structural heart disease (SHD). The study was conducted across 38 centers and followed patients for a median period of 10.8 years, achieving a high follow-up completion rate of 94.8%. It reported an overall 10-year all-cause mortality rate of 39.4%. However, outcomes diverged significantly between patient groups.

The individuals with structurally normal hearts expressed a markedly lower 10-year mortality rate of 12.1%, while patients with SHD underwent a higher mortality rate of 54.8%. Among SHD patients, the individuals with ischemic heart disease fared the worst, with an estimated 10-year mortality rate of 62.4%.

The mortality risk increased significantly with advancing age (hazard ratio [HR] 2.35 per decade). Also, a left ventricular ejection fraction of 30% or less was a strong predictor of mortality (HR 2.11).

Diabetes elevated mortality risk (HR 1.73), as did incessant VT episodes (HR 2.96). Acute procedural failure emerged as a pivotal factor, significantly impacting both VT recurrence (HR 3.76) and long-term mortality (HR 2.57).

Also, acute procedural success was the sole statistically significant predictor for reducing VT recurrence during follow-up. This finding illuminates the importance of achieving optimal outcomes during the initial ablation procedure to enhance long-term survival. The findings highlight catheter ablation as an effective treatment for reducing VT burden but emphasize the need for tailored management strategies, especially for patients with SHD or ischemic heart disease.

The results also reinforce the necessity of addressing modifiable risk factors such as diabetes and optimizing procedural techniques to improve outcomes. Overall, this study offers valuable insights into the long-term impact of VT ablation which provides a foundation for refining treatment protocols and improving patient care in the years ahead.

Reference:

Rottner, L., Metzner, A., Hochadel, M., Senges, J., Willems, S., Ince, H., Eckardt, L., Deneke, T., Lugenbiel, P., Brachmann, J., Chun, J., Tilz, R., & Rillig, A. (2024). Ten‐Year Outcomes and Predictors of Mortality Following Catheter Ablation of Ventricular Tachycardia. In Journal of the American Heart Association. Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1161/jaha.124.034814