Real-world outcomes of ventricular tachycardia catheter ablation with versus without intracardiac echocardiography

J Cardiovasc Electrophysiol. 2020 Feb;31(2):417-422. doi: 10.1111/jce.14324. Epub 2019 Dec 27.

Abstract

Introduction: By providing real-time monitoring of catheter-tissue interface and for complications, intracardiac echocardiography (ICE) during catheter ablation for ventricular tachycardia (VT) may improve outcomes. To test this hypothesis, we compared 12-month readmission rates (all-cause, cardiovascular [CV]-related, and VT-related), repeat ablation, and complications among patients with VT with structural heart disease undergoing ablation with versus without ICE.

Methods and results: Using the 2008-2017 IBM MarketScan Commercial and Medicare Supplemental databases, patients with a history of implantable cardioverter defibrillator/cardiac resynchronization therapy (ICD/CRT-D) who underwent VT ablation with and without ICE use were identified. Propensity matching was performed and regression analysis was used to compare outcomes. After matching, 1324 patients were identified (ICE: 662; non-ICE: 662). The rate of 12-month VT-related readmission (18.13% vs 22.51%; P < .05) and repeat VT ablation (14.35% vs 19.34%; P = .02) postindex discharge were lower among patients in the ICE group compared with the non-ICE group, with a 24% lower risk of 12-month VT-related readmission (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.58-0.99) and a 30% lower risk of repeat ablation (OR, 0.70; 95% CI, 0.52-0.93) vs non-ICE group. The 12-month all-cause (44.56% vs 43.20%; P = .62) and CV-related readmissions (35.20% vs 32.93%; P = 0.38) and complication rates were not significantly different between the two groups.

Conclusions: VT ablation using ICE was associated with a lower likelihood of 12-month VT-related readmission and repeat ablation compared with non-ICE patients.

Keywords: catheter ablation; claims database; intracardiac echocardiography; ventricular tachycardia.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Action Potentials
  • Adolescent
  • Adult
  • Aged
  • Catheter Ablation* / adverse effects
  • Catheter Ablation* / mortality
  • Databases, Factual
  • Echocardiography*
  • Female
  • Heart Rate
  • Humans
  • Male
  • Middle Aged
  • Patient Readmission
  • Predictive Value of Tests
  • Risk Assessment
  • Risk Factors
  • Tachycardia, Ventricular / diagnostic imaging
  • Tachycardia, Ventricular / mortality
  • Tachycardia, Ventricular / physiopathology
  • Tachycardia, Ventricular / surgery*
  • Time Factors
  • Treatment Outcome
  • Young Adult