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Brief Report
November 2016

Sex and Catheter Ablation for Ventricular TachycardiaAn International Ventricular Tachycardia Ablation Center Collaborative Group Study

Author Affiliations
  • 1Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
  • 2University of Chicago Medical Center, Chicago, Illinois
  • 3Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora
  • 4University of California Los Angeles Cardiac Arrhythmia Center, University of California Los Angeles Health System
  • 5Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York
  • 6Brigham and Women’s Hospital, Boston, Massachusetts
  • 7Intermountain Medical Center Heart Institute, Murray, Utah
  • 8Veteran’s Affairs Medical Center, University of Minnesota, Minneapolis
  • 9University of Kansas Medical Center, Kansas City
  • 10University of Maryland Medical Center, Baltimore
  • 11Baylor St Luke’s Medical Center/Texas Heart Institute, Houston
  • 12Hospital San Raffaele, Milan, Italy
  • 13Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
  • 14Texas Cardiac Arrhythmia Institute, St David’s Medical Center, Austin
JAMA Cardiol. 2016;1(8):938-944. doi:10.1001/jamacardio.2016.2361
Key Points

Question  How do outcomes compare between women and men with structural heart disease undergoing ventricular tachycardia ablation?

Findings  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.

Meaning  Whether the worse outcome observed in women is owing to referral bias, more challenging arrhythmia substrate or undertreatment requires further study.

Abstract

Importance  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.

Objective  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.

Exposures  Catheter ablation.

Main Outcomes and Measures  Ventricular tachycardia–free survival and transplant-free survival were compared between women and men. Cox proportional hazard modeling was performed.

Results  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.

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