Predictors of In-Hospital Mortality After DC Catheter Ablation of Atrioventricular Junction: Results of a Prospective, International, Multicenter Study

BACKGROUNDThe Catheter Ablation Registry was the first international, multicenter, pro-spective study of the safety and efficacy of catheter ablation. METHODS AND RESULTSFrom August 1987 through March 1990, the study comprised 136 patients in whom only DC energy was used in attempted production of t...

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Published in:Circulation (New York, N.Y.) N.Y.), 1991-11, Vol.84 (5), p.1924-1937
Main Authors: Evans, G Thomas, Scheinman, Melvin M, Bardy, Gust, Borggrefe, Martin, Brugada, Pedro, Fisher, John, Fontaine, Guy, Huang, S K. Stephen, Huang, Wei Hua, Josephson, Mark, Kuck, Karl-Heinz, Hlatky, Mark A, Levy, Samuel, Lister, John W, Marcus, Frank, Morady, Fred, Tchou, Patrick, Waldo, Albert L, Wood, Douglas
Format: Article
Language:English
Subjects:
Biological and medical sciences
Bundle of His - surgery
Cardiac dysrhythmias
Cardiology. Vascular system
Electrocoagulation
Female
Heart
Heart Block - etiology
Hospital Mortality
Humans
Male
Medical sciences
Middle Aged
Postoperative Complications - mortality
Prospective Studies
Registries
Risk Factors
Tachycardia - mortality
Tachycardia, Supraventricular - surgery
Ventricular Fibrillation - mortality
Ventricular Function, Left - physiology
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Summary:BACKGROUNDThe Catheter Ablation Registry was the first international, multicenter, pro-spective study of the safety and efficacy of catheter ablation. METHODS AND RESULTSFrom August 1987 through March 1990, the study comprised 136 patients in whom only DC energy was used in attempted production of third-degree atrioven-tricular block to treat uncontrollable supraventricular tachycardias. Eight patients died during hospitalization for ablation. In seven (5.1%), the ablation may have contributed to their deaths. Causes of death included ventricular fibrillation (five patients, three with polymorphic ventricular tachycardia), progressive heart failure (one patient), and respiratory failure (two patients, one dying after resuscitation from ventricular fibrillation). Compared with survivors, patients who died were more likely to have had prior aborted sudden death (38% versus 2%, p< 0.05), congestive heart failure (88% versus 22%, p < 0.001), cardiomyopathy (50% versus 16%, p< 0.05), lower baseline systolic blood pressure (106 versus 138 mm Hg, p< 0.001), prolonged baseline and postablation corrected QT interval (p< 0.01), and markedly reduced ejection fraction (27% versus 52%, p< 0.001). Ablation successfully produced third-degree atrioventric-ular block in 88% of the patients who died and in 83% of survivors. CONCLUSIONSCatheter ablation of the atrioventricular junction with DC energy carries a significant, previously unrecognized risk of death (5.1%), particularly from lethal arrhythmias, when applied to patients with severe left ventricular dysfunction. Great care should be taken in these seriously ill patients to guard against postablation ventricular arrhythmias.
ISSN:0009-7322
1524-4539
DOI:10.1161/01.cir.84.5.1924