How do outcomes compare between women and men with structural heart disease undergoing ventricular tachycardia ablation?
In this multicenter, observational study of 2062 patients, women (n = 262) had significantly higher rates of ventricular tachycardia recurrence in the year following ablation than men (30.5% vs 25.3%) despite being younger, with higher left ventricular ejection fraction and fewer medical comorbidities.
Whether the worse outcome observed in women is owing to referral bias, more challenging arrhythmia substrate or undertreatment requires further study.
Significant differences have been described between women and men regarding presentation, mechanism, and treatment outcome of certain arrhythmias. Previous studies of ventricular tachycardia (VT) ablation have not included sufficient women for meaningful comparison.
To compare outcomes between women and men with structural heart disease undergoing VT ablation.
Design, Setting, and Participants
Investigator-initiated, multicenter, observational study performed between 2002 and 2013, conducted by the International VT Ablation Center Collaborative Group, consisting of 12 high-volume ablation centers. Consecutive patients with structural heart disease undergoing VT ablation were studied. Structural heart disease was defined as left ventricular ejection fraction less than 55%, hypertrophic cardiomyopathy, or right ventricular cardiomyopathy, with scar confirmed during electroanatomic mapping.
Main Outcomes and Measures
Ventricular tachycardia–free survival and transplant-free survival were compared between women and men. Cox proportional hazard modeling was performed.
Of 2062 patients undergoing ablation, 266 (12.9%) were women. Mean (SD) age was 62.4 (13.3) years and 1095 (53.1%) had ischemic cardiomyopathy. Compared with men, women were younger, with higher left ventricular ejection fraction and less VT storm. Despite this, women had higher rates of 1-year VT recurrence following ablation (30.5% vs 25.3%; P = .03). This difference was only partially explained by higher prevalence of nonischemic cardiomyopathy among women and was actually most pronounced among those with ischemic cardiomyopathy.
Conclusions and Relevance
In 12 high-volume ablation centers, women with structural heart disease have worse VT-free survival following ablation than men. Whether this is owing to differences in referral pattern, arrhythmia substrate, or undertreatment requires further study.
Frankel DS, Tung R, Santangeli P, Tzou WS, Vaseghi M, Di Biase L, Nagashima K, Tedrow U, Bunch TJ, Tholakanahalli VN, Dendi R, Reddy M, Lakkireddy D, Dickfeld T, Weiss JP, Mathuria N, Vergara P, Patel M, Nakahara S, Vakil K, Sauer WH, Callans DJ, Natale A, Stevenson WG, Della Bella P, Shivkumar K, Marchlinski FE. Sex and Catheter Ablation for Ventricular TachycardiaAn International Ventricular Tachycardia Ablation Center Collaborative Group Study. JAMA Cardiol. 2016;1(8):938-944. doi:10.1001/jamacardio.2016.2361