Catheter Ablation of Postinfarction Ventricular Tachycardia: Ten-Year Trends in Utilization, In-Hospital Complications, and In-Hospital Mortality in the United States

Heart Rhythm. 2014 Nov;11(11):2056-63. doi: 10.1016/j.hrthm.2014.07.012. Epub 2014 Jul 9.

Abstract

Background: There is a paucity of data regarding the complications and in-hospital mortality after catheter ablation for ventricular tachycardia (VT) in patients with ischemic heart disease.

Objective: The purpose of this study was to determine the temporal trends in utilization, in-hospital mortality, and complications of catheter ablation of postinfarction VT in the United States.

Methods: We used the 2002-2011 Nationwide Inpatient Sample (NIS) database to identify all patients ≥18 years of age with a primary diagnosis of VT (International Classification of Diseases, Ninth Edition, Clinical Modification [ICD-9-CM] code 427.1) and who also had a secondary diagnosis of prior history of myocardial infarction (ICD-9-CM 412). Patients with supraventricular arrhythmias were excluded. Patients who underwent catheter ablation were identified using ICD-9-CM procedure code 37.34. Temporal trends in catheter ablation, in-hospital complications, and in-hospital mortality were analyzed.

Results: Of 81,539 patients with postinfarct VT, 4653 (5.7%) underwent catheter ablation. Utilization of catheter ablation increased significantly from 2.8% in 2002 to 10.8% in 2011 (Ptrend < .001). The overall rate of any in-hospital complication was 11.2% (523/4653), with vascular complications in 6.9%, cardiac in 4.3%, and neurologic in 0.5%. In-hospital mortality was 1.6% (75/4653). From 2002 to 2011, there was no significant change in the overall complication rates (8.4% to 10.2%, Ptrend = .101; adjusted odds ratio [per year] 1.02, 95% confidence interval 0.98-1.06) or in-hospital mortality (1.3% to 1.8%, Ptrend = .266; adjusted odds ratio [per year] 1.03, 95% confidence interval 0.92-1.15).

Conclusion: The utilization rate of catheter ablation as therapy for postinfarct VT has steadily increased over the past decade. However, procedural complication rates and in-hospital mortality have not changed significantly during this period.

Keywords: Catheter ablation; Outcomes; Registry; Trends; Ventricular tachycardia.

MeSH terms

  • Aged
  • Catheter Ablation / statistics & numerical data*
  • Female
  • Hospital Mortality*
  • Humans
  • Middle Aged
  • Myocardial Infarction / complications*
  • Postoperative Complications / mortality
  • Registries
  • Risk Factors
  • Tachycardia, Ventricular / etiology*
  • Tachycardia, Ventricular / mortality*
  • Tachycardia, Ventricular / surgery*
  • United States
  • Utilization Review