İskemik Ventriküler Taşikardisi Olan Hastalarda Radyofrekans Kateter Ablasyonu Tedavisinin Hastalık Sonlanımlarına Etkisinin Değerlendirilmesi

Abstract

OKŞUL M. Evaluating the Effect of Radiofrequency Catheter Ablation Treatment on the Disease Outcomes of the Patients with Ischemic Ventricular Tachycardia, Hacettepe University Faculty of Medicine, Cardiology Thesis, Ankara, 2019. Scar homogenization based catheter ablation has lower recurrence rates than clinical ventricular tachycardia (VT) catheter ablation in patients with recurrent ischemic VT episodes. The purpose of this study is to define the success and recurrence rates of the scar homogenization based radiofrequency (RF) catheter ablation, complications of this procedure, pre and post-procedural mortality and the predictors of the outcome depending on patient and procedure in patients with ischemic cardiomyopathy and VT. Patients that received catheter ablation between the dates of 01.06.2014 - 30.11.2018 due to ischemic VT were included in the study. The basic characteristic features of the patients such as age, gender, comorbidity and routine pre-procedural laboratory parameters, prescribed drugs and echocardiographic parameters were recorded. As the endpoints of the study, continuous VT attack development, history of treatment of the patients with implantable cardioverter defibrillator (ICD), in-hospital, early and late mortality rates and pre-procedural complications were evaluated. The study population included 128 patients as 120 male (93.8%) and 8 female (6.2%) patients. The mean age of the patients were found as 66±10 years. The ratio of the patients that applied to the hospital with electrical storm before ablation was found as 40.6% (52). Mean left ventricular ejection fraction (LVEF) of the patients was 29.6%±7.2 and LVEF was found as <%30 in 57.8% of the patients. When the complications were evaluated in all population, it was found that 4.7% of the patients had pre-procedural complication, 2.3% had minor complication and 2.3% had major complication. VT recurrence was observed in 34.4% of the patients during the median follow-up of 22,5 (1-54) months. All-cause mortality rate was 30.5% during the follow-up period. LVEF was found as an independent risk factor in terms of mortality. According to the results of this study, in patients with ischemic cardiomyopathy (ICMP) and that received RF VT ablation; percutaneous coronary intervention (PCI) history (HR:2,65; %95 CI:1,28-5,58; p=0,010), applying to the hospital with electrical storm (HR:1,96; %95 CI:1,07-3,58; p=0,039) and LVEF lower than 30% (HR:6,31; %95 CI:1,48-26,94; p=0,013) were found as the most significant predictors of recurrence; Diabetes Mellitus (DM) presence (HR:2,86; %95 CI:1,48-5,51; p=0,002), having NYHA>2 (HR:1,91; %95 CI:1,05-3,66; p=0,045), LVEF (HR:0,95; %95 CI:0,91-0,98; p=0,038) and brain natriuretic peptide (BNP) levels (HR:1,10; %95 CI:1,03-1,18; p=0,004) were found as the most significant predictors of the all-cause mortality; LVEF level (; HR:0,93; %95 CI:0,88-0,98; p=0,013), BNP level (HR:1,07; %95 CI:1,02-1,11; p=0,002) and proper shock amount after first ablation procedure (HR:1,12; %95 CI:1,03-1,22; p=0,011) were found as the most significant predictors of the cardiovascular mortality. Keywords: Ischemic heart disease, Catheter ablation, Ventricular tachicardia.