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Turagam MK, Musikantow D, Goldman ME, Bassily-Marcus A, Chu E, Shivamurthy P, Lampert J, Kawamura I, Bokhari M, Whang W, Bier BA, Malick W, Hashemi H, Miller MA, Choudry S, Pumill C, Ruiz-Maya T, Hadley M, Giustino G, Koruth JS, Langan N, Sofi A, Dukkipati SR, Halperin JL, Fuster V, Kohli-Seth R, Reddy VY. Malignant Arrhythmias in Patients With COVID-19: Incidence, Mechanisms, and Outcomes. Circ Arrhythm Electrophysiol 2020; 13:e008920. [PMID: 33026892 PMCID: PMC7668347 DOI: 10.1161/circep.120.008920] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Patients with coronavirus disease 2019 (COVID-19) who develop cardiac injury are reported to experience higher rates of malignant cardiac arrhythmias. However, little is known about these arrhythmias—their frequency, the underlying mechanisms, and their impact on mortality. Methods: We extracted data from a registry (NCT04358029) regarding consecutive inpatients with confirmed COVID-19 who were receiving continuous telemetric ECG monitoring and had a definitive disposition of hospital discharge or death. Between patients who died versus discharged, we compared a primary composite end point of cardiac arrest from ventricular tachycardia/fibrillation or bradyarrhythmias such as atrioventricular block. Results: Among 800 patients with COVID-19 at Mount Sinai Hospital with definitive dispositions, 140 patients had telemetric monitoring, and either died (52) or were discharged (88). The median (interquartile range) age was 61 years (48–74); 73% men; and ethnicity was White in 34%. Comorbidities included hypertension in 61%, coronary artery disease in 25%, ventricular arrhythmia history in 1.4%, and no significant comorbidities in 16%. Compared with discharged patients, those who died had elevated peak troponin I levels (0.27 versus 0.02 ng/mL) and more primary end point events (17% versus 4%, P=0.01)—a difference driven by tachyarrhythmias. Fatal tachyarrhythmias invariably occurred in the presence of severe metabolic imbalance, while atrioventricular block was largely an independent primary event. Conclusions: Hospitalized patients with COVID-19 who die experience malignant cardiac arrhythmias more often than those surviving to discharge. However, these events represent a minority of cardiovascular deaths, and ventricular tachyarrhythmias are mainly associated with severe metabolic derangement. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04358029.
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Affiliation(s)
- Mohit K Turagam
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Daniel Musikantow
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Martin E Goldman
- Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Adel Bassily-Marcus
- Department of Critical Care Medicine, Institute for Critical Care Medicine (A.B.-M., R.K.-S.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Edward Chu
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Poojita Shivamurthy
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joshua Lampert
- Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Iwanari Kawamura
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mahmoud Bokhari
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - William Whang
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Benjamin Aaron Bier
- Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Waqas Malick
- Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Helen Hashemi
- Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Marc A Miller
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Subbarao Choudry
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Christopher Pumill
- Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Tania Ruiz-Maya
- Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael Hadley
- Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gennaro Giustino
- Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jacob S Koruth
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Noelle Langan
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Aamir Sofi
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Srinivas R Dukkipati
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jonathan L Halperin
- Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Valentin Fuster
- Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Roopa Kohli-Seth
- Department of Critical Care Medicine, Institute for Critical Care Medicine (A.B.-M., R.K.-S.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Vivek Y Reddy
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
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Turagam MK, Garg J, Whang W, Sartori S, Koruth JS, Miller MA, Langan N, Sofi A, Gomes A, Choudry S, Dukkipati SR, Reddy VY. Catheter Ablation of Atrial Fibrillation in Patients With Heart Failure: A Meta-analysis of Randomized Controlled Trials. Ann Intern Med 2019; 170:41-50. [PMID: 30583296 DOI: 10.7326/m18-0992] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED This article has been corrected. The original version (PDF) is appended to this article as a Supplement. BACKGROUND Atrial fibrillation (AF) and heart failure (HF) frequently coexist and are associated with increased morbidity and mortality risk. PURPOSE To compare benefits and harms between catheter ablation and drug therapy in adult patients with AF and HF. DATA SOURCES ClinicalTrials.gov, PubMed, Web of Science (Clarivate Analytics), EBSCO Information Services, Cochrane Central Register of Controlled Trials, Google Scholar, and various scientific conference sessions from 1 January 2005 to 1 October 2018. STUDY SELECTION Randomized controlled trials (RCTs) published in English that had at least 6 months of follow-up and compared clinical outcomes of catheter ablation versus drug therapy in adults with AF and HF. DATA EXTRACTION 2 investigators independently extracted data and assessed study quality. DATA SYNTHESIS 6 RCTs involving 775 patients met inclusion criteria. Compared with drug therapy, AF ablation reduced all-cause mortality (9.0% vs. 17.6%; risk ratio [RR], 0.52 [95% CI, 0.33 to 0.81]) and HF hospitalizations (16.4% vs. 27.6%; RR, 0.60 [CI, 0.39 to 0.93]). Ablation improved left ventricular ejection fraction (LVEF) (mean difference, 6.95% [CI, 3.0% to 10.9%]), 6-minute walk test distance (mean difference, 20.93 m [CI, 5.91 to 35.95 m]), peak oxygen consumption (Vo2max) (mean difference, 3.17 mL/kg per minute [CI, 1.26 to 5.07 mL/kg per minute]), and quality of life (mean difference in Minnesota Living with Heart Failure Questionnaire score, -9.02 points [CI, -19.75 to 1.71 points]). Serious adverse events were more common in the ablation groups, although differences between the ablation and drug therapy groups were not statistically significant (7.2% vs. 3.8%; RR, 1.68 [CI, 0.58 to 4.85]). LIMITATION Results driven primarily by 1 clinical trial, possible patient selection bias in the ablation group, lack of patient-level data, open-label trial designs, and heterogeneous follow-up length among trials. CONCLUSION Catheter ablation was superior to conventional drug therapy in improving all-cause mortality, HF hospitalizations, LVEF, 6-minute walk test distance, Vo2max, and quality of life, with no statistically significant increase in serious adverse events. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Mohit K Turagam
- Mount Sinai Hospital, New York, New York (M.K.T., J.G., W.W., S.S., J.S.K., M.A.M., N.L., A.S., A.G., S.C., S.R.D., V.Y.R.)
| | - Jalaj Garg
- Mount Sinai Hospital, New York, New York (M.K.T., J.G., W.W., S.S., J.S.K., M.A.M., N.L., A.S., A.G., S.C., S.R.D., V.Y.R.)
| | - William Whang
- Mount Sinai Hospital, New York, New York (M.K.T., J.G., W.W., S.S., J.S.K., M.A.M., N.L., A.S., A.G., S.C., S.R.D., V.Y.R.)
| | - Samantha Sartori
- Mount Sinai Hospital, New York, New York (M.K.T., J.G., W.W., S.S., J.S.K., M.A.M., N.L., A.S., A.G., S.C., S.R.D., V.Y.R.)
| | - Jacob S Koruth
- Mount Sinai Hospital, New York, New York (M.K.T., J.G., W.W., S.S., J.S.K., M.A.M., N.L., A.S., A.G., S.C., S.R.D., V.Y.R.)
| | - Marc A Miller
- Mount Sinai Hospital, New York, New York (M.K.T., J.G., W.W., S.S., J.S.K., M.A.M., N.L., A.S., A.G., S.C., S.R.D., V.Y.R.)
| | - Noelle Langan
- Mount Sinai Hospital, New York, New York (M.K.T., J.G., W.W., S.S., J.S.K., M.A.M., N.L., A.S., A.G., S.C., S.R.D., V.Y.R.)
| | - Aamir Sofi
- Mount Sinai Hospital, New York, New York (M.K.T., J.G., W.W., S.S., J.S.K., M.A.M., N.L., A.S., A.G., S.C., S.R.D., V.Y.R.)
| | - Anthony Gomes
- Mount Sinai Hospital, New York, New York (M.K.T., J.G., W.W., S.S., J.S.K., M.A.M., N.L., A.S., A.G., S.C., S.R.D., V.Y.R.)
| | - Subbarao Choudry
- Mount Sinai Hospital, New York, New York (M.K.T., J.G., W.W., S.S., J.S.K., M.A.M., N.L., A.S., A.G., S.C., S.R.D., V.Y.R.)
| | - Srinivas R Dukkipati
- Mount Sinai Hospital, New York, New York (M.K.T., J.G., W.W., S.S., J.S.K., M.A.M., N.L., A.S., A.G., S.C., S.R.D., V.Y.R.)
| | - Vivek Y Reddy
- Mount Sinai Hospital, New York, New York (M.K.T., J.G., W.W., S.S., J.S.K., M.A.M., N.L., A.S., A.G., S.C., S.R.D., V.Y.R.)
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Kusa S, Miller MA, Whang W, Enomoto Y, Panizo JG, Iwasawa J, Choudry S, Pinney S, Gomes A, Langan N, Koruth JS, d’Avila A, Reddy VY, Dukkipati SR. Outcomes of Ventricular Tachycardia Ablation Using Percutaneous Left Ventricular Assist Devices. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004717. [DOI: 10.1161/circep.116.004717] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 04/28/2017] [Indexed: 01/22/2023]
Abstract
Background—
Although percutaneous left ventricular assist devices (pLVADs) facilitate mapping and ablation of hemodynamically unstable ventricular tachycardia (VT), there is limited data whether clinical outcomes are improved. We sought to retrospectively compare the outcomes of patients undergoing scar-related VT ablation with and without pLVAD support.
Methods and Results—
The study population comprised 194 patients (109 pLVAD and 85 non-pLVAD). The pLVAD group more often had dilated cardiomyopathy (33% versus 13%;
P
=0.001), New York Heart Association heart failure class ≥III (51% versus 25%;
P
<0.001), lower left ventricular ejection fractions (26±10% versus 39±16%;
P
<0.001), and electrical storm (49% versus 34%;
P
=0.04). Procedure times (422±112 versus 330±92 minutes;
P
<0.001), postablation VT inducibility (20% versus 7%;
P
=0.02), and length of subsequent hospitalization (median 6 versus 4 days;
P
=0.001) were all higher in the pLVAD group. During median follow-up of 215 days, the primary end point (recurrent VT, heart transplantation, or death) occurred in 36% of the pLVAD versus 26% of the non-pLVAD groups (
P
=0.14). After propensity matching for differences between groups, no differences were seen between groups for both acute procedural outcomes and the primary end point.
Conclusions—
In this large single-center scar-related VT ablation experience, despite the worse clinical status of the patients selected for pLVAD support, clinical outcomes were better than expected and were similar to healthier patients not receiving hemodynamic support. Patients with dilated cardiomyopathy presenting with electrical storm, advanced heart failure, and severe left ventricular dysfunction most frequently received hemodynamic support during VT ablation.
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Affiliation(s)
- Shigeki Kusa
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
| | - Marc A. Miller
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
| | - William Whang
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
| | - Yoshinari Enomoto
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
| | - Jorge G. Panizo
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
| | - Jin Iwasawa
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
| | - Subbarao Choudry
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
| | - Sean Pinney
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
| | - Anthony Gomes
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
| | - Noelle Langan
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
| | - Jacob S. Koruth
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
| | - Andre d’Avila
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
| | - Vivek Y. Reddy
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
| | - Srinivas R. Dukkipati
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
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