Abstract
Purpose
The PAINESD risk score was developed in 2015 as a tool to stratify the risk of acute hemodynamic decompensation during ventricular tachycardia (VT) ablation in structural heart disease patients and further then used for post procedure 30-day mortality prediction. The original cohort however did not include Chagas disease (ChD) patients. We aim to evaluate the relevance of the score in a ChD population.
Methods
The PAINESD risk score gives weighted values for specific characteristics (chronic obstructive pulmonary disease, age > 60 years, ischemic cardiomyopathy, New York Heart Association [NYHA] functional class 3 or 4, ejection fraction less than 25%, VT storm, and diabetes). The score was applied in a retrospective cohort of ChD VT ablations in a single tertiary center in Brazil. Data were collected by VT study reports and patient record analysis at baseline and on follow-up.
Results
Between January 2013 and December 2018, 157 VT catheter ablation procedures in 121 ChD patients were analyzed. Overall, 30-day mortality was 9.0%. Multivariate analysis correlated NYHA functional class (HR 1.78, 95% CI 1.03–3.08, P 0.038) and the need for urgent surgery (HR 31.5, 95% CI 5.38–184.98, P < 0.001), as well as a tendency for VT storm at presentation (HR 2.72, 95% CI 0.87–8.50, P 0.084) as risk factors for the primary endpoint. The median PAINESD risk score in this population was 3 (3–8). The area under the receiver operating characteristic (ROC) curve was 0.64 (95% CI 0.479–0.814).
Conclusions
The PAINESD risk score did not perform well in predicting 30-day mortality in ChD patients. Pre-procedure NYHA functional class and the need for urgent surgery due to refractory pericardial bleeding were independently associated with increased 30-day mortality. Prospective studies are needed to take final conclusions in Chagas disease when using PAINESD score.
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References
Guandalini GS, Liang JJ, Marchlinski FE. Ventricular tachycardia ablation: past, present, and future perspectives. JACC Clin Electrophysiol. 2019;5(12):1363–83.
Bhaskaran A, Tung R, Stevenson WG, Kumar S. Catheter ablation of VT in non-ischaemic cardiomyopathies: endocardial, epicardial and intramural approaches. Heart Lung Circ. 2019;28(1):84–101.
Santangeli P, Muser D, Zado ES, Magnani S, Khetpal S, Hutchinson MD, et al. Acute hemodynamic decompensation during catheter ablation of scar-related ventricular tachycardia: incidence, predictors, and impact on mortality. Circ Arrhythm Electrophysiol. 2015;8(1):68–75.
Santangeli P, Frankel DS, Tung R, Vaseghi M, Sauer WH, Tzou WS, et al. Early mortality after catheter ablation of ventricular tachycardia in patients with structural heart disease. J Am Coll Cardiol. 2017;69(17):2105–15.
Bocchi EA, Bestetti RB, Scanavacca MI, Cunha Neto E, Issa VS. Chronic Chagas heart disease management: from etiology to cardiomyopathy treatment. J Am Coll Cardiol. 2017;70(12):1510–24.
Shen L, et al. Contemporary characteristics and outcomes in chagasic heart failure compared with other nonischemic and ischemic cardiomyopathy. Circ Heart Fail. 2017;10(11).
Rassi FM, Minohara L, Rassi A Jr, Correia LCL, Marin-Neto JA, Rassi A, et al. Systematic review and meta-analysis of clinical outcome after implantable cardioverter-defibrillator therapy in patients with Chagas heart disease. JACC: Clin Electrophysiol. 2019;5(10):1213–23.
Martinelli M, de Siqueira SF, Sternick EB, Rassi A Jr, Costa R, Ramires JAF, et al. Long-term follow-up of implantable cardioverter-defibrillator for secondary prevention in Chagas’ heart disease. Am J Cardiol. 2012;110(7):1040–5.
Scanavacca M. Epicardial ablation for ventricular tachycardia in chronic Chagas heart disease. Arq Bras Cardiol. 2014;102(6):524–8.
Mello RP, et al. Delayed enhancement cardiac magnetic resonance imaging can identify the risk for ventricular tachycardia in chronic Chagas’ heart disease. Arq Bras Cardiol. 2012;98(5):421–30.
Pisani CF, Romero J, Lara S, Hardy C, Chokr M, Sacilotto L, et al. Efficacy and safety of combined endocardial/epicardial catheter ablation for ventricular tachycardia in Chagas disease: a randomized controlled study. Heart Rhythm. 2020;17(9):1510–8.
Duran-Crane A, Rojas CA, Cooper LT, Medina HM. Cardiac magnetic resonance imaging in Chagas’ disease: a parallel with electrophysiologic studies. Int J Card Imaging. 2020;36(11):2209–19.
Sosa E, et al. A new technique to perform epicardial mapping in the electrophysiology laboratory. J Cardiovasc Electrophysiol. 1996;7(6):531–6.
Vakil KP, Roukoz H, Tung R, Levy WC, Anand IS, Shivkumar K, et al. Mortality prediction using a modified Seattle Heart Failure Model may improve patient selection for ventricular tachycardia ablation. Am Heart J. 2015;170(6):1099–104.
Killu AM, Sugrue A, Munger TM, Hodge DO, Mulpuru SK, McLeod CJ, et al. Impact of sedation vs. general anaesthesia on percutaneous epicardial access safety and procedural outcomes. Europace. 2018;20(2):329–36.
Nof E, Reichlin T, Enriquez AD, Ng J, Nagashima K, Tokuda M, et al. Impact of general anesthesia on initiation and stability of VT during catheter ablation. Heart Rhythm. 2015;12(11):2213–20.
Nagashima K, Choi EK, Tedrow UB, Koplan BA, Michaud GF, John RM, et al. Correlates and prognosis of early recurrence after catheter ablation for ventricular tachycardia due to structural heart disease. Circ Arrhythm Electrophysiol. 2014;7(5):883–8.
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Kulchetscki, R.M., Pisani, C.F., Alexandre, F.K.B. et al. Applicability of the PAINESD risk score for 30-day mortality prediction post ventricular tachycardia catheter ablation in Chagas disease. J Interv Card Electrophysiol 62, 469–477 (2021). https://doi.org/10.1007/s10840-021-00995-z
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DOI: https://doi.org/10.1007/s10840-021-00995-z