Abstract
Objective and background
Catheter-based treatment of patients with ventricular arrhythmias (VA) reduces VA and mortality in selected patients. With regard to potential risks of catheter ablation, a benefit–risk assessment should be carried out. This can be performed with risk scores such as the recently published “Risk in Ventricular Ablation (RIVA) Score”. We sought to validate this score and to test for possible additional predictors in a large database of VT ablations.
Methods and results
We analyzed 1964 catheter ablations for VA in patients with (1069; 54.4%) and without (893, 45.6%) structural heart disease (SHD) and observed an overall major adverse event rate of 4.0% with an in-hospital mortality of 1.3% with significantly less complications occurring in patients without structural heart disease (6.5% vs. 1.1%; p ≤ 0.01). The RIVA Score demonstrated to be a valid predictive tool for major in-hospital complications (OR 1.18; 95% CI 1.12, 1.25; p ≤ 0.001). NYHA Class ≥ III (OR 2.5; 95% CI 1.5, 4.2; p < 0.001) and age (OR 1.04; 95% CI 1.02, 1.07; p ≤ 0.001) proved to be additional predictive parameters. Hence, a modified RIVA Score (mRIVA) model was analyzed with a subset of established predictors (SHD, eGFR, epicardial puncture) as well as new predictive parameters (age, NYHA Class ≥ III), that achieved a higher predictive value for major complications compared with the model based on all RIVA variables.
Conclusion
Adding age and functional heart failure status (NYHA class) as simple clinical parameters to the recently published RIVA Score increases the predictive value for ablation-associated complications in a large VT ablations registry.
Graphical abstract
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Data availability
The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.
Abbreviations
- VA:
-
Ventricular arrhythmia
- SHD:
-
Structural heart disease
- RIVA:
-
Risk in Ventricular Ablation
- eGFR:
-
Estimated glomerular filtration rate
- VT:
-
Ventricular tachycardia
- PVC:
-
Premature ventricular contraction
- SD:
-
Standard deviation
- IQR:
-
Interquartile range
- OR:
-
Odds ratio
- CI:
-
Confidence interval
- LVEF:
-
Left ventricular ejection fraction
- NICM:
-
Non-ischemic cardiomyopathy
- ICM:
-
Ischemic cardiomyopathy
- DCM:
-
Dilatative cardiomyopathy
- ARVC:
-
Arrhythmogenic right ventricular cardiomyopathy
- LV:
-
Left ventricle
- RV:
-
Right ventricle
- OAC:
-
Oral anticoagulation
- DAPT:
-
Dual anti-platelet therapy
- mRIVA:
-
Modified Risk In Ventricular Ablation
- NYHA:
-
New York Heart Association
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Doldi, F., Doldi, P.M., Plagwitz, L. et al. Predictors for major in-hospital complications after catheter ablation of ventricular arrhythmias: validation and modification of the Risk in Ventricular Ablation (RIVA) Score. Clin Res Cardiol 112, 1778–1789 (2023). https://doi.org/10.1007/s00392-023-02223-2
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DOI: https://doi.org/10.1007/s00392-023-02223-2