Ablation of Outflow Tract Arrhythmias in Patients With and Without Structural Heart Disease-A Comparative Analysis

Ruben Schleberger; Jan Riess; Anika Brauer; Hans O Pinnschmidt; Laura Rottner; Fabian Moser; Julia Moser; Shinwan Kany; Ilaria My; Marc D Lemoine; Bruno Reissmann; Christian Meyer; Andreas Metzner; Feifan Ouyang; Paulus Kirchhof; Andreas Rillig

doi:10.3389/fcvm.2022.910042

Ablation of Outflow Tract Arrhythmias in Patients With and Without Structural Heart Disease-A Comparative Analysis

Front Cardiovasc Med. 2022 May 25:9:910042. doi: 10.3389/fcvm.2022.910042. eCollection 2022.

Authors

Ruben Schleberger^{1

2}, Jan Riess¹, Anika Brauer¹, Hans O Pinnschmidt³, Laura Rottner^{1

2}, Fabian Moser¹, Julia Moser¹, Shinwan Kany¹, Ilaria My¹, Marc D Lemoine^{1

2}, Bruno Reissmann¹, Christian Meyer^{4

5}, Andreas Metzner¹, Feifan Ouyang^{1

6}, Paulus Kirchhof^{1

7}, Andreas Rillig¹

Affiliations

¹ Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
² DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany.
³ Institute of Medical Biometry and Epidemiology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁴ Department of Cardiology, Cardiac Neuro- and Electrophysiology Research Consortium, Protestant Hospital Düsseldorf, Düsseldorf, Germany.
⁵ Cardiac Neuro- and Electrophysiology Research Consortium, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
⁶ Hong Kong Asian Medical Group, Hong Kong, China.
⁷ Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.

Abstract

Introduction: Catheter ablation of ventricular arrhythmias emerging from the ventricular outflow tracts and adjacent structures is very effective and considered almost curative in patients without structural heart disease (SHD). Outcomes of patients with SHD undergoing ablation of outflow tract arrhythmias are not known.

Methods: Consecutive patients (2019-2021) undergoing catheter ablation of ventricular arrhythmias in a single high-volume center were retrospectively analyzed. Patients with ablation of outflow tract arrhythmias were identified and divided in individuals with and without SHD. Procedural parameters and acute outcome were compared.

Results: We identified 215 patients with outflow tract arrhythmias (35.3% female, mean age 58.3 ± 16.0 years). Of those, 93 (43.3%) had SHD. Patients with SHD and outflow tract arrhythmias were older (65.0 ± 12.8 vs. 53.3 ± 16.3 years; p < 0.001), more often male (82.8 vs. 50.0%; p < 0.001) and had more comorbidities than patients without SHD (arterial hypertension: 62.4 vs. 34.4%, p < 0.001; diabetes: 22.6 vs. 8.2%, p = 0.005; chronic lung disease: 20.4 vs. 7.4%, p = 0.007). Outflow tract arrhythmias in patients with SHD had their origin more often in the left ventricle (68.8 vs. 53.3%, p = 0.025). The acute success rate was similar in both patient groups (93.4 vs. 94.2%, p = 0.781). Patients with SHD were discharged later {median length of hospital stay with SHD 5 [6 (interquartile range)] days, without SHD 2 [4] days, p < 0.001}. Periprocedural complications were numerically more frequent in patients with SHD [with SHD 12 (12.9%), without SHD 8 (6.6%), p = 0.154].

Conclusion: Outflow tract arrhythmia ablation has a high success rate irrespective of the presence of SHD. Longer hospital stay and potentially a higher risk of periprocedural complications should be considered when discussing this treatment option with patients.

Keywords: catheter ablation; outflow tract arrhythmia; premature ventricular complexes; procedural outcome; structural heart disease; ventricular tachycardia.