Abstract 14706: Severity of Coronary Atherosclerosis Does Not Predict Hemodynamic Intolerance of Ventricular Tachycardia During Catheter Ablation

• Published in: Circulation (New York, N.Y.) Vol. 140; no. Suppl_1 Suppl 1; p. A14706
• Main Authors: Davogustto, Giovanni E, Cluckey, Andrew, Kanagasundram, Arvindh, Montgomery, Jay A, Shen, Sharon, John, Roy M, Michaud, Gregory F, Stevenson, William G
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 19.11.2019
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.140.suppl_1.14706

BackgroundCatheter ablation (CA) is an important treatment for recurrent monomorphic ventricular tachycardia (VT). Hemodynamic intolerance (HI) of induced VTs limits catheter mapping and may increase procedure risk. Whether severity of coronary disease (CAD) is a determinant of HI is not known.ObjectiveTo determine if CAD severity is associated with HI or need for mechanical circulatory support (MCS), and occurrence of ventricular fibrillation (VF) and procedure complications during catheter ablation.MethodsA retrospective analysis of 51 consecutive patients undergoing VT CA at Vanderbilt University Medical Center who had anatomic coronary evaluation within the preceding 24 months was performed. Univariate and multivariate logistic regression included number of territories with non-revascularized obstructive coronary atherosclerosis (≥50% epicardial disease), VT cycle length (< 320 ms), LVEF, type of sedation and number of sedative agents used.ResultsHI occurred in 24 (47%), HI/MCS in 25 (49%), VF in 10 (19%) and major complications in 12 (23%) patients. Non-revascularized obstructive CAD was present in 16 patients with a median of 1 territory involved. Patients with obstructive CAD had higher rates of ACEI/ARB use, smoking and required less sedatives, but had similar age, sex, LVEF and frequency of DM, HTN, atrial fibrillation and type of anesthesia used. On multivariate analysis, increasing territories with obstructive CAD were not associated with HI, HI/MCS, or VF during CA. VT cycle length < 320 ms was associated with HI and HI/MCS. LVEF was associated with VF (Table). Furthermore, obstructive CAD was not associated with increased complications after VT CA (OR 0.36; 0.7 - 1.86).ConclusionIn patients with VT requiring CA, the severity of obstructive CAD is not associated with HI, increased burden of VF, or major complications during CA. In our series, the key determinants of HI and VF were VT cycle length and LVEF, respectively.