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453083 - Outcomes of Mapping and Catheter Ablation ...
Outcomes of Mapping and Catheter Ablation Techniqu ...
Outcomes of Mapping and Catheter Ablation Techniques For the Treatment of VT Session
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All right, everyone, good afternoon, everyone. I'm really pleased on the name of the Heart Rhythm Society to be able to chair that session. We're still waiting for the other co-moderator, therefore, as he's not there, I think we're going to start just in a matter of time. So the first poster, we have six really interesting subjects today. The first one is presented by Dr. Zhang, and she will talk about digital right ventricular cardiomyopathy ablation targeting can reduce 3D ablation in ARVC, therefore, Dr. Zhang. Hello, everyone. I'm Nancy Zhang from Dr. Natalia Tranova's lab at Johns Hopkins University. And today, it's my honor to present my project here. The patient-specific digital right ventricular cardiomyopathy ablation targeting, RVCAT, can reduce redo ablations in ARVC. So, ARVC is an inherited cardiomuscle disorder, and over 60% of them are due to non-pathogenic variants. And the major hallmarks of ARVC include structural and electrophysiological remodeling, and they are progressive and extensive throughout the patient's heart. As they progress to a certain stage, they lead to arrhythmia. Catheter ablation is a very common treatment of ARVC. However, the procedure itself leads to multiple clinical challenges. For example, finding all the VT locations to ablate is very time-consuming, as it needs extensive mapping. And also, imprecise selection of ablation targets can lead to excessive ablation lesions, which have negative consequences for patients with ARVC, who originally have abnormal inflammatory response. And also, a recent study has shown that there's a high VT recurrence rate in ARVC after ablation, which leads to repeated trauma to the patients. So, in order to address all these clinical challenges, our study aims to demonstrate a digital pipeline we have developed. The RVCAT can accurately predict VT circuits and ablation targets for both the index and redo ablations of ARVC patients. Therefore, this pipeline might have potential to be used in clinical settings to reduce the VT recurrence rate. So, here's the RVCAT pipeline we have developed. We started from the LGCMR, and we used ARVC-specific image processing techniques to classify the voxels into three categories. And then we reconstruct the 3D models of these different tissue types, and we use rapid pacing to induce in silico VT circuits. And as the first step of validation, we compare our in silico VT circuit location to the EPS-induced VT circuits. And then we move on to the RVCAT ablation computation, which is an iterative process of eliminating all these in silico VT circuits. And after terminating all these, we exported the final in silico ablation sites and compared them to the clinical ablation sites from electroanatomical mapping data. One special highlight here is that we have incorporated genotype-specific EP properties into our digital harm models in order to describe the abnormal functionality of ionic channels due to ARVC genetic mutation. So, in our previous study, RVCAT was implemented in a cohort of eight ARVC patients with no redo ablation history, and RVCAT had an excellent performance in predicting the ablation targets. So, we raised the question here, how will RVCAT help those patients with recurrent VTs? Here, as a retrospective approval concept, we included three patients who had VT recurrence and a redo ablation in less than 12 months after the index ablation. And for these patients, we make sure that the clinical ablation sites of redo and index procedures are different. We analyzed all these activation maps from our in silico rapid pacing, and our results show that RVCAT predicted VT locations match EPS-induced VT locations during both the index and redo procedures. We then compared RVCAT predicted ablation sites with the clinical ablation sites. And on the right side, you can see the blue dot stands for the initial index ablation sites, and dark red dot stands for the redo ablation sites, and the purple volume stands for in silico ablation sites, which is predicted by RVCAT. And you can see the purple volume is coinciding with the clinical ablation sites, and tend to have a smaller volume of lesions. And this result also demonstrates that our image processing techniques can describe the structural remodeling of these patients. Because in the bipolar voltage map, you can see the low voltage area is corresponding to our segmented fibrotic volume. So here we conclude that RVCAT can accurately predict VT circuits, locations, and ablation targets at once. And by integrating it into clinical workflows, it can help eliminate all the VTs at the index ablation and reduce the recurrence rate. RVCAT can also be used as a computational tool to investigate mechanisms of ARVC erythrogenesis. So here I would like to acknowledge the support from Dr. Natalia Tranova and all the lab members of Tranova Lab. I would also like to acknowledge the clinical data support and guidance from Dr. Hugh Calkins and all the members of Johns Hopkins ARVC research group, and thanks to all the contributors of this project. And thank you. My poster is right there in case you want to learn more details about this project. Really nice presentation. The paper is open for discussion. Do you have any questions from the audience? So I have one or two questions actually. So does the MRI is done, did you do an MRI between the ablation and the redo ablation? No. So it was done from the first MRI that was done before, and the, so ARVD is a evolutive disease, right? Do you think that, so how far can the MRI predict recurrences because the disease is going to increase with time. So what do you think about that? That is a fantastic question. That's why when we are including patients, we ensure that the redo ablation and initial ablation has only 12 months in between. So we are isolating the impact of progression of this disease. And so the, the targets on only on scars, or you look at the VT that the patient has as well, do you, do you have like 12 LKG of the VT or it's only the targets already done with the scars morphology? Yes, this model is image based. So we are seeing the structural substrate, which is the fibroid region and scar region as the major substrate. And I also mentioned that we also include genotype specific EP properties, which is a major, which is a very important feature of ARVC because in ARVC patients, there tend to be ionic channel remodeling due to genetic mutation. So that is also a major driver of the VT circus. And the last question. Yeah, go ahead. So I just want to follow. Yeah. Good. Okay. Just want to follow up on, on your, your comment about the, what you're using to identify the VTs. Dr. Trianova's lab has, has, has, has pioneered this virtual EP study. And I think that's what you were asking, right? Like, you know, so, so this, this sounds like it's more, more predicting the sites rather than the actual, actual VTs. Correct. Okay. And then the second part of my question was, was, do you think this works well for patients with ARVC that have, that have one, one morphology versus like more than one morphology? And, you know, do you think it's, it's was there any, anything in the data that, that, that suggested that it works, works as well, regardless of how many VTs you have? So this study majorly predicts VT locations. So we, because VT location is the one that decide where to apply it in our study. So we only focus on VT locations instead of predicting the unique morphologies. Yeah. I think that's it. Thanks for that. So are you my co-moderator? Do we have Dr. Benzal here? There was no poster update neither, so maybe upload. So maybe Dr. Benzal is not here. So we might go to the third one. So Dr. Oh is going to talk about prospective real-time use of forward-solution EKG mapping to facilitate focus activation mapping and unstable VT accretion outcomes. And Dr. Oh is coming from UCSD. Thank you very much for having me here. Today I'm going to talk about an exciting study of using real-time computational 12-lead ECG-guided mapping to facilitate invasive activation mapping and ablation of hemodynamically unstable VT. And we're going to look at the accuracy and the outcomes of this approach. So for anybody who ablates VT, we all know that hemodynamically unstable VT is very difficult to map. When we have a patient with hemodynamically unstable VT, you know, the blood pressure is going down, anesthesia is yelling at you, your nurses are yelling at you, and the defib is alarming and charging, and you're expected at the same time to be looking at little fractionated signals, mid-diastolic signals, and then your catheter's getting stuck in the chordae, in the papillary muscles, and then you're also deciding whether or not to pace terminate or do you just go straight to defib. And so, you know, there's a lot of complexity in this sick group of patients. So we've been developing a system that uses only the 12-lead ECG and using machine learning and computational simulations throughout both ventricles, we can predict the VT exit sites based on just the 12-lead ECG. And because these simulations are done ahead of time, the mapping doesn't require a lot of competing power, and once we have the 12-lead induced either in the lab or even from the ER or from the clinic, well, probably not the clinic for VT, but in an inpatient setting, we can take the MUSE ECGs and digitize it and map the targets ahead of time and have it displayed on a 3D model as you see here. This is the output of the ECG mapping. We've previously validated this in a blinded clinical trial of 225 patients at four centers published in Circulation EP. But the objective of this study is a very focused group of patients with all who have hemodynamically unstable VT consecutively mapped prospectively with ECG mapping. And we are assessing the feasibility of ECG mapping to facilitate invasive activation mapping. We're looking at the accuracy of ECG mapping compared to only activation with or without entrainment mapping. And then we're looking at the clinical outcomes of VT recurrence, ICD therapy reduction, and safety in these patients who have undergone ECG mapping. So the workflow that we've developed in these patients is that we first take the clinical VT 12-lead ECG and usually we induce it in the lab, which is the first thing we do. Sometimes we've had a couple of patients where we've actually been able to just use their EKG when they present it in the ER or when they're in ICU. And we can map it ahead of time and we will have this target. Recently, we've also developed a workflow that we can export the target and integrate it into any DICOM-supported mapping system including ESI that is shown here or CARDO. And what we can do is we export this VT target and it becomes this purple dot and we can fuse it to a CT to have a patient-specific geometry and then integrate it into the site. Once we have access and we are able to get our mapping catheter into the ventricle, then we would just strategically place the multi-electrode catheter at the site of the mapping target of the prediction and then we would induce VT and be able to grab a quick activation map before needing to defibrillate. In this case, we were lucky. Even though the patient was hypotensive, just putting our catheter at the site terminated the VT with a bump. So in eight of the patients that underwent perspective ECG mapping, seven of the patients had hemodynamically unstable VT. The other patient had stable VT which we also activation mapped and he was an ischemic with a slower VT. But we're focusing on the unstable VT patients so all seven out of the seven were able to undergo successful activation mapping and ablation. Half of them were ischemic, half of them were non-ischemic. And what we found was that there was a 98% reduction in total ICD therapies and that includes ATP and shocks. Their VT recurred in two months in one of the seven patients. We had a mean follow-up of five months and in our accuracy analysis, we include everybody that underwent perspective ECG guidance and the mean accuracy was within 1.3 centimeters in blinded comparison. So I have a different case here. This is a 82-year-old male with ischemic cardiomyopathy. We localized the EKG to the basal inferior LV on the ECG mapping. And when we positioned our catheter here and reinduced the VT, we had these mid-diastolic signals here and we were able to quickly map the whole critical isthmus here and it terminated with ablation. Before we, actually in this case, we were able to quickly do an entrainment verifying this was the exit site in this patient. So you can see the mid-diastolic signals here and this is the PPI minus TCL of zero, concealed entrainment and termination with ablation at this exit site. So I like to include that real-time computational 12-lead ECG mapping can help facilitate activation mapping and ablation of hemodynamically unstable VT. We found excellent VT suppression in this small cohort. We found good accuracy and there were no complications and we actually felt that this speeded up the procedure and eliminated unnecessary mapping in irrelevant areas of the heart. I'm available to take any questions. Good answer. Thank you. Yeah, this is really interesting. So just to clarify for the audience, so we're identifying the exit site of the VT circuit, which could be, it's not necessarily a focal arrhythmia. It could be a scar-related VT and the ECG mapping identifies the exit site. So my question is, how much of the substrate, you do some substrate mapping, I assume, beforehand. You get at least the 3D geometry and you can get voltage from the 3D geometry. And I was just curious to look under the hood a little bit and understand how much of the electroanatomic mapping that you obtained before you do your fancy ECG method is used and then finally also, how much time then also did you, once you identified the site and you re-induced, did you typically have to map the local area? These are great questions. I'm gonna start first with the substrate question because substrate mapping and ablation is a cornerstone of VT ablation. And what we've actually found is having the exit site does guide us with substrate mapping ahead of time because before we even enter the chamber with our high-density catheter, we know the area, like is it the basal part of the inferior wall like we have here, then what we would do is, during sinus rhythm, when we're creating the geometry, we focus on that area, grab those late potentials, we can even do, we do ILAM mapping, when we do N-site, it's difficult to do dynamic window all the time, but we do characterize some of the substrate but it's very targeted. We don't have to map on the opposite side of the heart and we would do that only if we induce another VT that would tell us that there's more substrate on the other side. And so what we found is that having these targets does shorten the time for both substrate mapping and activation mapping. And so in terms of our ablation strategy, you might be asking about how much homogenization did we do. We only, we did limited homogenization in contiguous lesions in the area of interest. So we would not homogenize the whole scar, we didn't do core isolation. So the method doesn't require, it doesn't require the voltage on the map, it's just based purely on the ECG and the geometry, right? Correct. We, you know, that clinically we, of course, since we already have a catheter in there, we're gonna substrate map and we do still factor that in to our ablation lesion strategy, but usually it's always in relation to trying to identify where the critical isthmus is and doing efficient lesions. We last, I think at ACC we presented a study in which we looked at the time savings and we found that there was like a 33% reduction in mapping time and fluoroscopy time when we integrated this technique. Do you need to use CAN in the head of the procedure? Because I don't understand without any mapping how you can localize where is the BT exit, first of all. How precise it is, do you think that you'll be able to find an endocardial exit between endo and AP exit? And would you be, is it accurate enough for a patient who would be too sick, that's three question, I'm sorry about that, to do radiotherapy ablation on those patient, someone that you don't want to bring to the lab? Excellent questions. Your first question is about, do you need a CT scan? Okay, so no. In order to get your electrical target, to be able to get from EKG to here does not require a CT scan. The only reason I brought up CT scan was if you want to integrate it, a patient-specific geometry into N-site, then we can use a CT scan to do it. We don't have to, we can also do it on a generic model and not have a CT scan at all, and no imaging. Second thing is radiotherapy is something that we actually do a lot of at UC San Diego, and our approach is using 12-lead ECG mapping to guide all of the VT targets. We've done that in 15 patients already. Does the room have any other question? That's really a nice poster. It's really interesting. It's exciting, actually. We're gonna pass to the next one. Thank you. I'm looking for Dr. Lee. We're a little bit in advance, so maybe we should wait a little bit before, where do you want to go? Wait. I'm just scared that people's gonna leave if we're waiting too much. I think you better. Yeah, so we're gonna change the order That's it Jire gyre gyre. Dr. Gyre. Dr. Gyre from Stony Brook is gonna talk about as SGL t2 for ablation outcomes in VT for VT ablation outcomes Hello everyone, thank you for joining us today and I wanted to thank the Heart Rhythm Society for asking me here to present our work and to Drs. Bilcek and Raymond for moderating this session. My name is Chad Guyer, I'm a second year general cardiology fellow at Stony Brook University Hospital on Long Island, New York and will be applying to EP fellowships this upcoming cycle so wish me luck. For those of you in the audience who participate in MedTwitter or are interested in Twitter, I will preface this by saying maybe you shouldn't believe everything that you read on the internet but I recently did see a tweet that said that when people come to these kind of short talks there's really only one key take-home message that you can really gain from these short kind of talks. So I actually want to start with our conclusion which you can see highlighted by the blue box in the middle of the screen and that in our study we found that SGLT2 inhibitor use at the time of VT ablation was associated with lower risk of mortality, hospitalization and repeat ablation during a two-year follow-up period. So again, just wanted to highlight that SGLT2 inhibitor use prior to VT ablation improves our patient's outcomes. So to kind of go through the study more in depth, starting with the background, initially when SGLT2 inhibitors were being studied for patients in heart failure, some initial studies that were published in heart rhythm case reports actually noted there was an increase in arrhythmias detected on implantable devices after initiation of SGLT2 inhibitors. Subsequent studies, most notably that in the DAPA-HF trial in post-talk analysis found there was actually a decrease in specifically in ventricular arrhythmias and sudden cardiac death in those patients by 21%. SGLT2 inhibitors, however, have not been specifically evaluated in the effects of the outcomes of patients undergoing procedures such as VT ablation. Therefore the objective of our study was to determine the outcomes of these patients specifically. Moving on to the methods, this was a retrospective study using the Trinetics Research Network which includes over 100 million patients globally but is mostly concentrated in the United States. We used current procedural terminology codes to identify the patients that underwent VT ablation aged 18 years or older from 2014 to 2021. These patients after being identified undergoing the procedure were matched from those using SGLT2 inhibitors and those were not through a myriad of comorbidities of over 20 different factors and demographic data. The outcomes specifically that we evaluated were mortality, stroke, hospitalization, redo ablations and antiarrhythmic use during a two-year follow-up period. Moving on to the results, using our methods we identified about 1,200, 500 patients overall that underwent VT ablation, 582 of which were taking SGLT2 inhibitors at the time of their procedures. Again those 582 patients were matched to those patients that were not taking SGLT2 inhibitors at the time of ablation. I did not put the kind of table one up here because it would probably take up the entire slide because there's so many things but just so you guys have an idea of the patient population, the mean age was 63, 77% of the patients were white, 82% were men, 85% of these patients had heart failure, the mean EF was just around 36%, 50% had AFib, about 70% had diabetes and about one-third of the patients had CKD and 53% had implanted ICDs at the time of their procedures. As you can see on the Kaplan-Meier curves on the far left here, these are actually one minus survival, so more of event rates that are being charted here but starting at the top, significant decrease in the risk of mortality, the second is hospitalization and the third for repeat ablation during the two-year follow-up period. We did not observe a difference between antiarrhythmic use or strokes in these patients. So again just to conclude, our study found that SGLT2 inhibitor use at the time of ablation was associated with improved outcomes in our patients and I think it's really something that we should consider getting our patients on prior to having these types of procedures. Thank you all very much. I'm happy to meet you all later at Poster 117 right here front and center if you want to chat afterwards. Wonderful talk. Thanks for that. So you use propensity matching to control for differences between groups. So perhaps you can comment on how good you think the propensity matching was. I'm going to ask you two questions. That's going to be the first thing. How happy were you with the propensity matching in terms of accounting for all unmeasured confounders and that sort of thing? And then I thought it was also curious that only about half of the patients had defibrillators but yet most of them did have heart failure and wondering what you think might be the reason for this, maybe geographic patterns of care and that sort of thing, differences in practice among different countries. Both excellent questions. Thank you very much. To answer your first question, I think I did forget to mention this, there was actually great matching. There was no significant differences between the groups after matching. The standard difference between the groups of all was less than 0.1 so we were happy with that. To answer your second question, again 85% did have heart failure and I think to your point it is curious why so few had ICDs. I think a limitation of the Trinitics database specifically is that we don't have hospital level data so it's more based upon region. So I think it could be just differences in practices, maybe community versus more academic, how aggressive are these places at putting people in ICDs and things like that. So I think that is a little bit something that is curious. It is a mean so the mean EF was 36. Some were much lower, some were higher. Did you control for geographic region and urban versus rural settings? We did not specifically control for the different regions, no. You didn't control for other drugs neither because there is always a question of bias. Who is treated with that medication? Do they receive Entresto? Do they receive anti-arrhythmic drugs as well? I did not mention this but we did control for the medication. So 98% of these patients were on beta blockers. About 80% in the 80s were on ACE-ARB or Entresto. I think similar to other heart failure trials, a low percentage were on MRAs, maybe like 30% to 40% but that is similar to other heart failure trials. So really we need to do a better job at getting our patients on good GDMT. So your study is from 2014-2021 and the SGLT-2 for heart failure was published in 2019 I think in New England. So do you think there is a time effect as well in your result? There definitely could be. So I think Depagliflozin was the first SGLT-2 that was approved for heart failure specifically. That was in 2020 I believe. So a lot of these patients probably were on SGLT-2 inhibitors actually for diabetes rather than the heart failure indication initially, yes. Did you also have a year, that's a really good point about the fact that this preceded a little bit the SGLT-2 inhibitors, but was the year of ablation or was there any time parameter that you used in the propensity matching? This was just a two-year follow-up period so I think it would be interesting to see maybe if there was a difference before approval and after approval of the SGLT-2 inhibitors specifically for heart failure. So I think that's a great subset we can look at. Thank you all very much. Any questions from the room? Thanks a lot. Thanks a lot for the talk. Everyone is interested in SGLT-2 after ablation I guess, huh? Yeah, but we just in with 20 minutes in advance, so we need to Yeah, if Dr. Lee Dr. Lee Now so we're just gonna wait for another 15 minutes because we're a little bit in advance so if someone has any question feel free Right there, better? All right, excellent. So, I'm John Kadat, I'm one of the third year cardiology fellows over at Bay State Medical Center in Springfield, Massachusetts. I'll be starting my EP fellowship at Yale in July, so pretty excited to be here. So, the title of my presentation today is The Safety and Outcomes of VT Ablation Across Age Groups. And we all know that a pharmacological approach to the treatment of VT is frequently tolerated by poor tolerance, medication uncompliance, and persistent ICD shocks. So, in a lot of these patients, it's quite burdensome and in a very elderly population above 80, we know that they've got significant comorbidities, they're some of our sickest and most delicate patients, so we really have to look at them more closely when opting for an ablation or an invasive approach to treating their VT rather than a pharmacotherapy approach. And, you know, interestingly, prior studies have shown that elderly, or very elderly patients over 80 in specific, undergoing VT ablation have higher risk of complications and ICD shocks, but demonstrate comparable short-term survival rates to younger subgroups. And elderly patients were found to have higher in-hospital and one-year mortality, though. However, once again, those were limited to younger patients under the age of 80 more so than what we're looking at, which is very elderly population above 80. Looking at the study, you know, it'll be very hard to randomize patients that are under the age of 80, or even over the age of 80 to these types of interventions, so we wanted to examine the safety and outcomes of catheter ablation of VT across age groups using the NIS database. So, for those not familiar with the NIS database, it is the largest publicly available all-payer inpatient healthcare database. It contains data from eight million hospital stays covering all of the United States, 97% of the population is covered, and results from this database have shown to correlate quite well with other hospitalization discharge databases. Just keep in mind that these patients are hospitalized, they are inpatient, and, you know, there aren't any planned procedures that we can think of, such as outpatient procedures or short hospital stays. So, we identified patients over the age of 21 with VT as the primary diagnosis that underwent ablation during the hospitalization. We divided them into four age groups, between 20 and 40, 40 to 59, 60 to 79, and over the age of 80 years old. The primary outcomes all caused mortality, and secondary outcomes were transfer to rehab, hospital length of stay, and in-hospital complications. We used univariate and multivariate logistic regression analyses to study the association between ablation and the primary and secondary outcomes. This is our patient characteristics. We can see that, dividing them into age groups, the majority of them were male patients, especially as you get over the age of 80. Over 85% were male. The average age was about 83 for the very elderly group, and you can see the younger subgroups. The number of procedures was mostly done in the ages of 60 to 79, and that's kind of our highest incidences of MI, and our patient population that can quite withstand some procedures, and less so in above 80, but it's quite still a substantial number of 2,260 procedures for this patient group. The younger population, about 1,330, but those are probably also quite sick patients if they're ongoing VT ablation at that young age group. The majority of patients, as you get older, were white, and the comorbidities, just looking down across, they were quite significant, and the more elderly we get, the higher the comorbidities of things like CHF, CKD, the Charleston's Comorbidity Index of over three, which is a weighted index score of how sick patients are, including, no, obesity, I don't think there was much difference. They were actually more obese if they were younger, and so were they more hypertensive. So, going to results, we actually found no differences in complications, including procedure-related pericardial effusion, pericarditis, tamponade, stroke, hemorrhage, or respiratory failure between all age groups. We found no differences in hospital length of stay across ages either. However, the mortality rates were significantly higher in octogenarians, 4.2% compared to those between 60 and 79 at 3.2%, 40 to 59 at 1.5%, and 2.3% between the ages of 20 and 39. Rehab transfer was all significantly higher in the elderly population, which also would make sense. This is a table of the complications and outcomes of all patients undergoing VT ablation divided by their age groups, and we can see that trending towards significance was pericarditis, and actually we found no patients over the age of 80 with pericarditis as a diagnosis in this database. We postulate that the younger you are, maybe the more aggressive providers are in ablating and leading higher incidence of pericarditis, but again, these are only postulations we can make. Tamponade was also not significantly higher, but higher in the younger age group, but mortality stayed highest in the elderly population. No patients between the age of 20 and 39 were transferred to rehab, and about 15% over the age of 80 had to transfer to rehab. So, of course, this is a, you know, it's an NIS database, it's a registry database, it's a snapshot in time, we have no follow-up data. Correlation does not imply causation, and we cannot say whether or not in-hospital mortality is related to the ablation. However, you know, we are also relying on proper ICD coding to make these associations. But, you know, it is a large sample size of octogenarians undergoing procedures. It does mimic real-world data, and it is hypothesis-generating, and I saw this quote recently. Actually, I didn't put it up there, but it goes by science, tells us what we can do, trials tell us what we should do, and databases tells us what we are doing. So there is some data we can pull out of this and extrapolate to trials and more important studies. So, that's about it. In conclusion, this large real-world database, we found no significant difference in procedure-related complications, but we did find higher in-hospital mortality rates and transfer to rehab in our larger patient, in our older patient population. So, that's all I have. Thank you. Hey, great, great, great presentation. The National Inpatient Sample is certainly, you know, an accessible database that can allow us to look at questions in large numbers of patients. Like any administrative data set, though, you know, there are going to be some limitations in terms of what you can get. And so, I was gonna ask you about that a little bit. So, you say VT ablation now, that can mean a lot of different things in terms of billing. You know, PVC ablations are gonna be different from ischemic VT ablations. And so, I was hoping you could comment on what criteria you used to select the patients from this and, you know, what you think the range of procedures that they were actually having done was, you know, from RV alfalotract, you know, PVC ablation, to, you know, ischemic VT with compromised EF. That's a great question, and it's something that we also thought about doing this, of course. And we, in ICD coding, we are at the, you know, we are at mercy of the way they code and the way we index these as VT patients. And we only included ventricular tachycardia. We weren't able to go by RVOT versus LVOT VT or PVCs. So, that is one limitation, strong limitation of the NIS database that we were not able to further stratify, yeah. And then, you know, another issue is just follow-up time. I don't think you said exactly how much follow-up time there was. Now, certainly, you know, if you're over the age of 80, none of us live forever. So, you know, eventually, you know, everyone's gonna die of something and it's gonna happen sooner if you're over the age of 80. So, any sense of whether these deaths were related to the procedure or within what timeframe they occurred? So, like I said, this is inpatient hospitalization, only so the deaths would have happened inpatient during the index ablation. We have no follow-up. That's a different database. So, it's all in-hospital mortality. Really nice presentation, but I'm really impressed by the number of patients who had VT ablation over 80. I don't think that's something really common that we do in Montreal, Canada. One of the questions I have for you, do you think there's some bias in the selection of those patients? Because if you choose a patient over 80, there's maybe a reason why you choose that patient. Maybe he's afraid the index is less bad than the normal 80 patient that you have usually. So, do you think that, because if you look at the study, should we think it's safe to do ablation on every patient over 80, or you still think there's some kind of selection that we need to do? Yeah, I certainly think that there definitely will be a selection that we need to do, but one thing we can go by with our patient characteristics, we did see that they were much higher comorbidities in those above 80. So, that's something we can anchor onto and go with, saying that they were sicker, but definitely in that population group, there's gonna be a spectrum of how sick they are. I still think that we can't really deduce the conclusion of, oh, everyone over 80 can undergo it. I still do think you do have to pick your patients that are very elderly undergoing the procedure, but we can go by this to say, hey, if we wanna say, are they at high risk of tamponade? Are they at high risk of stroke? We didn't find that, but they still would be at high risk of mortality if they were to experience any of those complications. That's what we found, and that's what we could go with, if that answers your question. Pretty well. Do you have any question from the audience? Thanks a lot, Dr. Cadavo. Thanks a lot.
Video Summary
The study aimed to examine the safety and outcomes of ventricular tachycardia (VT) ablation across different age groups. The researchers used the National Inpatient Sample (NIS) database, which contains data from hospital stays in the United States, covering 97% of the population. They identified patients over the age of 21 who underwent VT ablation and divided them into four age groups: 20-39, 40-59, 60-79, and over 80. The primary outcome was all-cause mortality, and secondary outcomes included transfer to rehab, hospital length of stay, and in-hospital complications. The study found no significant differences in complications or hospital length of stay across age groups. However, mortality rates were significantly higher in octogenarians (over 80) compared to the other age groups. Additionally, transfer to rehab was more common in the older age groups. The researchers concluded that while VT ablation appears to be safe across age groups, mortality rates are higher in octogenarians. This study provides insights into the outcomes of VT ablation in different age groups and highlights the need for careful patient selection, particularly in very elderly patients.
Keywords
Ventricular tachycardia ablation
Age groups
National Inpatient Sample database
All-cause mortality
Hospital length of stay
In-hospital complications
Octogenarians
Patient selection
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