Author + information
- Received September 13, 2018
- Revision received October 11, 2018
- Accepted October 12, 2018
- Published online January 21, 2019.
- Tomofumi Nakamura, MD, PhDa,b,
- Ryohsuke Narui, MD, PhDa,
- Qi Zheng, MDb,
- Hirad Yarmohammadi, MD, MPHb,
- Usha B. Tedrow, MD, MSb,
- Bruce A. Koplan, MD, MPHb,
- Gregory F. Michaud, MDa,
- William G. Stevenson, MDa and
- Roy M. John, MD, PhDa,∗ ()
- aCardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- bCardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Roy M. John, Vanderbilt Heart and Vascular Institute, 1215 21st Avenue South, Nashville, Tennessee 37232.
Objectives This study sought to evaluate the incidence and significance of atrioventricular (AV) block associated with ventricular arrhythmia (VA) ablation.
Background Attempted ablation of VAs that arise from the septum carries a risk of AV block.
Methods Data from 1,418 patients who had catheter ablation for drug-refractory VAs were evaluated. Two analyses were conducted. The first analysis assessed the patient and procedure characteristics associated with ablation-induced AV block. The second analysis investigated outcome differences between patients with and without AV block. For the second analysis, patients with AV block (Group I) were compared with a 1:2 propensity score–matched control group (Group II) and with patients with pre-existing AV block before ablation (Group III).
Results Twenty-one (1.6%) patients developed AV block. In multivariable analysis, nonischemic cardiomyopathy (odds ratio: 3.33; 95% confidence interval: 1.32 to 8.40; p = 0.011) and transcoronary ethanol ablation (odds ratio: 46.50; 95% confidence interval: 14.10 to 153.00; p < 0.001) were independently associated with AV block. Subsequent to the AV block, 9 patients were upgraded from an implantable cardioverter-defibrillator to cardiac resynchronization therapy with defibrillator (CRT-D), 2 had de novo CRT-D implantation, 5 had pre-existing CRT-D, and 5 had pacing without CRT. VAs recurred in 33% of patients in Group I, 17% in Group II (log-rank p = 0.842), and 35% in Group III (p = 0.636). The composite outcome of heart failure hospitalization, heart transplantation, or death occurred in 29% of patients in Group I, 17% in Group II (p = 0.723), and 45% in Group III (p = 0.303).
Conclusions Complete AV block occurs in fewer than 2% of patients undergoing VA ablation and does not appear to be associated with the worse outcome of heart failure hospitalization, heart transplantation, or death.
Drs. Nakamura and Narui have received a scholarship from the Japanese Heart Rhythm Society, Tokyo Japan. Dr. Tedrow has received speaker honoraria from Abbott Medical, Biosense Webster, Medtronic, and Boston Scientific. Dr. Michaud has received speaker honoraria from Boston Scientific, Biosense Webster, Abbott, Pfizer, Medtronic, and Biotronik. Dr. Stevenson has received speaker honoraria from Abbott Medical, St. Jude Medical, Boston Scientific, and Medtronic; and is also co-holder of a patent for needle ablation that is consigned to Brigham and Women’s Hospital. Dr. John has received speaker honoraria from Biosense Webster, Abbott, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received September 13, 2018.
- Revision received October 11, 2018.
- Accepted October 12, 2018.
- 2019 American College of Cardiology Foundation
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