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Safety and efficacy of catheter ablation for ventricular tachycardia in elderly patients with structural heart disease: a systematic review and meta-analysis

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Abstract

Purpose

Data regarding the age-specific outcomes of VT ablation in patients with structural heart disease (SHD) are scarce. We performed a systematic review and meta-analysis to evaluate the outcomes of VT ablation in elderly vs. younger patients with SHD.

Methods

MEDLINE/PubMed, Cochrane, and Google Scholar and references comparing VT ablation in elderly vs. younger patients were screened and studies included if matching inclusion and exclusion criteria.

Results

Five retrospective studies enrolling 2778 SHD patients (868 elderly vs. 1910 younger) were included. Compared to younger subjects, the elderly showed similar results in terms of acute ablation success (OR 0.78, 95% CI 0.54–1.13, p = 0.189) and minor complications (OR 1.74, 95% CI 0.74–4.09, p = 0.205), a trend toward a higher risk of major complications (OR 2.30, 95% CI 0.83–6.40, p = 0.110) and significantly higher rates of all complications (OR 2.67, 95% CI 1.51–4.71, p = 0.001) and periprocedural mortality (OR 1.93, 95% CI 1.24–3.01, p = 0.004). At a mean follow-up of 18 months, elderly patients showed similar long-term VT recurrence rate (OR 1.02, 95% CI 0.85–1.22, p = 0.861) and higher all-cause mortality (OR 2.00, 95% CI 1.40–2.86, p < 0.001). In elderly patients, urgent VT ablation is associated with higher risk of major complications (beta = 0.06, p < 0.001) and periprocedural mortality (beta = 0.03, p = 0.029), while advanced age is associated with higher risk of major complications (beta = 0.29 with p = 0.009) and all complications + periprocedural mortality (beta = 0.17 with p = 0.037).

Conclusions

Compared to younger patients, VT ablation in elderly showed similar results in terms of acute ablation success and long-term VT recurrence rate with a significantly higher risk of all complications, periprocedural mortality, and long-term mortality, especially when the procedure is performed urgently and in the most aged patients. Large prospective multicenter randomized trials are required to confirm these findings.

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Abbreviations

VT:

Ventricular tachycardia

SCD:

Sudden cardiac death

SHD:

Structural heart disease

ICD:

Implantable cardioverter-defibrillators

HF:

Heart failure

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

QUOROM:

Quality of reporting of meta-analyses

MOOSE:

Cochrane Collaboration and Meta-analysis of Observational Studies in Epidemiology

PICO:

Population, intervention, comparison, and outcome

IHD:

Ischemic heart disease

NIHS:

Non-ischemic heart disease

DM:

Diabetes mellitus

CKD:

Chronic kidney disease

VT CL:

VT cycle length

RF:

Radiofrequency

TIA:

Transient ischemic attack

NOS:

Newcastle–Ottawa scale

CI:

Confidence interval

OR:

Odds ratio

ES:

Electrical storm

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Authors and Affiliations

  1. Division of Cardiology, Mauriziano Umberto I Hospital, Corso Filippo Turati, 62, Turin, 10128, Italy

    Alessandro Blandino, Francesca Bianchi, Andrea Sibona Masi, Stefano Grossi & Giuseppe Musumeci

  2. Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    David S. Frankel

  3. Electrophysiology Section, Cardiovascular Division, University of Michigan, Ann Arbor, MI, USA

    Jackson J. Liang

  4. Molecular Cardiology, Istituti Clinici Scientifici Maugeri, Istituto Di Ricovero E Cura a Carattere Scientifico, Pavia, Italy

    Andrea Mazzanti

  5. Department of Molecular Medicine, University of Pavia, Pavia, Italy

    Andrea Mazzanti

  6. Department of Medical Sciences, Division of Cardiology, AOU Città Della Salute E Della Scienza, University of Turin, Turin, Italy

    Fabrizio D’Ascenzo

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  1. Alessandro Blandino
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Blandino, A., Bianchi, F., Frankel, D.S. et al. Safety and efficacy of catheter ablation for ventricular tachycardia in elderly patients with structural heart disease: a systematic review and meta-analysis. J Interv Card Electrophysiol 66, 179–192 (2023). https://doi.org/10.1007/s10840-021-01007-w

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