Complications of catheter ablation of ventricular tachycardia: a single-center experience.

BACKGROUND: Catheter ablation has become an established treatment modality for a broad spectrum of ventricular tachycardias (VTs). We analyzed incidence and predictors of major complications of VT ablation procedures in a high-volume expert center.

METHODS AND RESULTS: We evaluated 548 consecutive patients who underwent 722 ablation procedures, 473 (65.5%) for structural heart disease VT in the period 2006 to 2012. There were 45 (6.2%) major complications observed in 44 patients. Access site vascular complications were the most frequent (3.6%). Three patients (0.4%) had cardiac tamponade/hemopericardium, and 5 patients (0.7%) had a thromboembolic event. No procedural deaths occurred. Procedures for structural heart disease VT versus idiopathic VT had a significantly higher complication rate (8.0% versus 2.8%; P=0.006). Similarly, patients with electrical storm (10.1% versus 5.3%; P=0.04) and nonelective procedures (8.4% versus 3.5%; P=0.007) were at higher risk of complications. On multivariate analysis, age >70 years (P=0.01), serum creatinine >115 μmol/L (P=0.0003), and individual operator (P=0.0001) were the only independent predictors of complications. Overall 30-day mortality in the structural heart disease VT group reached 5.0% (patients) and 3.6% (procedures). Death was associated with early recurrence of VT/ventricular fibrillation (P=0.003) and ablation for electrical storm (P=0.02).

CONCLUSIONS: Complication rates for VT ablation are significantly lower in idiopathic VT or in elective procedures. Independent predictors of complications include age, renal insufficiency, and individual operator. Postprocedural mortality is predicted by early recurrence of VT/ventricular fibrillation and ablation for electrical storm.