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What Are the Risks From the Procedure?

The risk of any major complication for VT ablation in patients with structural heart disease (Ischemic and Non-ischaemic Cardiomyopathy) is approximately 6-8%.

The risk of major complications for VT ablation in patients with normal hearts (Idiopathic VT) is ~3%.

Major risks 1,2,3 of VT ablation in structural heart disease include but are not limited to:

  • The peri-procedural risk of death during a VT ablation in patients with structural heart disease has been reported as low as 0.4% and up to 3%.

  • The risk of major vascular complications (arteriovenous fistula, pseudo aneurysm, dissection) requiring surgery is 4% and minor vascular complications (hematoma in the leg) is 7%. Vascular complications are the most common major complication encountered during a VT ablation.

  • The risk of stroke or transient ischemic attack is 1-2% .

  • The risk of damage to the heart wall causing bleeding in the sac around the heart (cardiac tamponade) requiring drainage with another catheter or urgent cardiac surgery is 1% to 2%.

  • Damage to a major artery (aorta) or heart valve (These complications may require urgent vascular or open heart surgery to correct).

  • In patients with VT arising from the septum or near the fibers of the normal conducting system, there is a risk of heart block requiring permanent pacing.

  • Acute exacerbation of heart failure can occur after VT ablation due to either fluid infused via the ablation catheter or “stunning effects” of the ablation itself.

  • Deep vein thrombosis (DVT) at the site of vascular access can occur after the procedure but is minimized with routine prophylactic blood thinning medications in the postoperative period.

The risks of epicardial access and epicardial ablation include but are not limited to:

  • Intra-abdominal or thoracic bleeding that can require surgery in less than 1% of procedures. Some patients may also need blood transfusion as a result of major bleeding.

  • Damage to abdominal structures (liver, pancreas, bowel) or sub -diaphragmatic vessel as result of the epicardial needle has been described.

  • Perforation and bleeding of the right ventricle during epicardial access which in some instances requires open-heart surgery.

  • Damage to the coronary arteries or puncture of the lung (pneumothorax) as a result of the needle during epicardial access (rare).

  • If ablation is performed on the epicardial surface, damage to the coronary arteries leading to an acute heart attack is possible. However, a coronary angiogram will always be performed prior to any epicardial ablation to make sure the ablation site is not close to a major coronary vessel.

  • Damage of the phrenic nerve causing paralysis to one side of the diaphragm is possible if ablation is performed close to the nerve. Pacing is routinely performed from the tip of the ablation catheter to identify the course of the phrenic nerve to minimize the risk of phrenic nerve injury.

How successful is a VT ablation?

The success of VT ablation varies, depending on the patient’s specific heart condition that caused VT. The procedure is most effective in patients with otherwise normal hearts, in whom the success rate exceeds 90%. In patients with structural heart disease resulting from scar or cardiomyopathy, success rates range between 50% and 75% at 6 to 12 months. In cases when a patient experiences a recurrence, 2 of 3 patients will still have less VT than before the initial ablation.

This has been adapted from “Catheter Ablation of Ventricular Tachycardia” by Tung et al Circulation 2010, 122, e389-391.

References:

  1. Tung et al Circulation 2010;122:389-391
  2. Della Bella et al Circulation 2013;127:1359-1368
  3. Koplan et al Heart Rhythm 2011;8:1661-1666


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Melbourne Heart Rhythm is the arrhythmia service at the Department of Cardiology at the Royal Melbourne Hospital. We are comprised of a team of highly trained and dedicated health care professionals specializing in heart rhythm management. We have a strong focus on patient education and patient centered care. Our arrhythmia specialists have an international reputation of excellence in arrhythmia research and clinical arrhythmia management.