Author + information
- Received August 28, 2017
- Revision received November 30, 2017
- Accepted December 4, 2017
- Published online February 7, 2018.
- Jorge Romero, MDa,
- Luigi Di Biase, MD, PhDa,
- Juan Carlos Diaz, MDa,
- Renato Quispe, MD, MHSa,
- Xianfeng Du, MDb,
- David Briceno, MDa,
- Ricardo Avendano, MDa,
- Usha Tedrow, MD, MSc,
- Roy M. John, MDd,
- Gregory F. Michaud, MDd,
- Andrea Natale, MDa,
- William G. Stevenson, MDc,d and
- Saurabh Kumar, BSc(Med)/MBBS, PhDc,e,∗ ()
- aMontefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
- bDepartment of Cardiology, Ningbo First Hospital, Zhejiang Sheng, China
- cBrigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
- dDivision of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- eDepartment of Cardiology, Westmead Hospital, University of Sydney, Westmead New South Wales, Australia
- ↵∗Address for correspondence:
Dr. Saurabh Kumar, Department of Cardiology, Westmead Hospital, Darcy Road, Westmead 2145, Sydney, New South Wales, Australia.
Objectives This was a meta-analysis of published studies to examine the impact of early referral on outcomes after catheter ablation for ventricular tachycardia (VT) in patients with structural heart disease.
Background Patients are frequently referred for VT ablation after failure of antiarrhythmic drugs to control VT. Some studies have suggested that early referral might confer better outcomes.
Methods An electronic search was performed using major databases. The primary outcomes were long-term VT recurrence and total mortality. Secondary outcomes were acute procedural success and acute complications.
Results Three studies were included with a total of 980 patients (mean age 64 ± 12 years, 71% males). Mean follow-up was 29 ± 27 months. Early referral for VT ablation was associated with decreased VT recurrence and acute complications compared with late referral (relative risk: 0.69 [95% confidence interval: 0.58 to 0.82], p < 0.0001 and relative risk: 0.50 [95% confidence interval: 0.27 to 0.93], p = 0.03, respectively). There was no significant difference between early and late referral for total mortality and acute success.
Conclusions Late referral for VT ablation was associated with worse outcomes (VT recurrence and acute complications) in patients with structural heart disease, which suggests that early referral for VT ablation might be a reasonable consideration in this patient population.
- acute complications
- antiarrhythmic drugs
- catheter ablation
- early referral
- ischemic cardiomyopathy
- nonischemic cardiomyopathy
- ventricular tachycardia
- VT recurrence
Dr. Di Biase has served as a consultant for Biosense Webster, Stereotaxis, Boston Scientific, and Abbott; and has received honoraria from Medtronic, AtriCure, Pfizer, and Biotronik. Dr. Tedrow has served as faculty for fellows course for St. Jude Medical, Biosense Webster, and Boston Scientific. Dr. John has received honoraria from Abbott Medical. Dr. Natale has served as a consultant for Biosense Webster, Stereotaxis, Boston Scientific, and Abbott; and has received honoraria from Medtronic, AtriCure, Pfizer, EPiEP, and Biotronik. Dr. Stevenson has received honoraria from Boston Scientific; has a patent for needle ablation that is consigned to Brigham Hospital; and his spouse has received research support from St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. This work was presented as an oral poster at the Heart Rhythm Society Scientific Meeting on May 12, 2017, in Chicago, Illinois. Samuel Asirvatham, MD, served as the Guest Editor for this article.
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 August 28, 2017.
- Revision received November 30, 2017.
- Accepted December 4, 2017.
- 2018 American College of Cardiology Foundation
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