Author + information
- Received November 30, 2017
- Revision received January 22, 2018
- Accepted January 25, 2018
- Published online March 28, 2018.
- Jorge Romero, MDa,b,
- William G. Stevenson, MDa,c,
- Akira Fujii, MDa,
- Sunil Kapur, MDa,
- Samuel H. Baldinger, MDa,d,
- Nishaki K. Mehta, MDa,
- Roy M. John, MDa,c,
- Gregory F. Michaud, MDa,c,
- Laurence M. Epstein, MDe,
- Bruce A. Koplan, MDa,
- Usha B. Tedrow, MD, MSca and
- Saurabh Kumar, BSc(Med)/MBBS, PhDa,f,∗ ()
- aCardiovascular Division, Brigham and Women’s Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts
- bDepartment of Medicine (Cardiology), Montefiore-Einstein Center for Heart and Vascular Care, New York, New York
- cArrhythmia and Electrophysiology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- dDepartment of Cardiology, Bern University Hospital and University of Bern, Bern, Switzerland
- eZucker School of Medicine, Hofstra/Northwell, Northwell Health, Manhassett, New York
- fDepartment of Cardiology, Westmead Hospital, Sydney, Australia
- ↵∗Address for correspondence:
Dr. Saurabh Kumar, Department of Cardiology, Westmead Hospital, Hawkesbury Road, Sydney, New South Wales 2145, Australia.
Objectives This study sought to examine the relationship between the number of oral antiarrhythmic drug (AAD) failures before referral for ventricular tachycardia (VT) ablation and subsequent clinical outcomes.
Background Failure of AADs prompts referral for VT ablation.
Methods Consecutive patients (n = 669) with sustained VT who were referred for a first-time ablation were divided into 2 groups according to the number of oral class 1 or 3 AAD failures before referral: single-drug failure (≤1 AAD; n = 256) or multidrug failure (>1 AADs; n = 413). Outcomes were stratified according to underlying disease type (no structural heart disease [SHD] [n = 87]; ischemic cardiomyopathy [ICM] [n = 368]; and ischemic cardiomyopathy [NICM] [n = 214]) and reported at a mean follow-up of 35 ± 46 months.
Results Patients with multidrug failure, compared with patients with single-drug failure, had more advanced SHD and required more extensive ablation to control arrhythmia. Multidrug failure, compared with single-drug failure, was associated with lower ventricular arrhythmia–free survival in ICM (46 ± 4% vs. 58 ± 6%; p = 0.03) and NICM (26 ± 5% vs. 49 ± 6%; p = 0.008), but not in the absence of SHD (71 ± 8% vs. 85 ± 7%; p = 0.10). Overall survival was lower in multidrug failure versus single-drug failure groups in patients with ICM (71 ± 3% vs. 84 ± 4%; p = 0.03) and NICM (70 ± 5% vs. 88 ± 4%; p < 0.001). Multidrug failure was independently associated with a higher risk of ventricular arrhythmia recurrence (hazard ratio: 1.6; P = 0.01) and mortality in NICM (hazard ratio: 2.6; p = 0.008), but not in ICM.
Conclusions Patients with SHD and failure of multiple oral AADs before VT ablation referral have more advanced heart disease and worse clinical outcomes following ablation, especially in NICM.
- antiarrhythmic drugs
- catheter ablation
- ischemic cardiomyopathy
- nonischemic cardiomyopathy
- ventricular tachycardia
Dr. Kumar is a recipient of the Neil Hamilton Fairley Overseas Research scholarship co-funded by the National Health and Medical Research Council and the National Heart Foundation of Australia; and the recipient of the Bushell Traveling Fellowship funded by the Royal Australasian College of Physicians. Dr. Tedrow has received consulting fees or honoraria from Boston Scientific and St. Jude Medical; has received research funding from Biosense Webster and St. Jude Medical; and is on the Fellowship Course faculty for St. Jude Medical, Medtronic, Biosense Webster, and Boston Scientific. Dr. John has received consulting fees or honoraria from St. Jude Medical; and receives lecture honoraria from Biosense Webster and Abbott. Dr. Michaud has received consulting fees or honoraria from Boston Scientific, Medtronic, and St. Jude Medical; has received research funding from Boston Scientific and Biosense Webster; and has a received teaching honoraria from Biotronik. Dr. Epstein is a consultant with Spectranetics, Medtronic, and Abbott; and has received speakers' fees from Spectranetics, Medtronic, and Abbott. Dr. Koplan has received reserach grants from Biosense Webster and St. Jude Medical. Dr. Stevenson is co-holder of a patent for needle ablation that is consigned to Brigham and Women’s Hospital; and has received speaker’s honoraria from Boston Scientific and Abbott Medical. Dr Epstein receives consulting fees/honoraria from Boston scientific Corp., Medtronic, Inc., and Spectranetics Corp. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Francis Marchlinski, MD, served as Guest Editor for this paper.
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 November 30, 2017.
- Revision received January 22, 2018.
- Accepted January 25, 2018.
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