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Predictors for major in-hospital complications after catheter ablation of ventricular arrhythmias: validation and modification of the Risk in Ventricular Ablation (RIVA) Score

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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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Correspondence to Florian Doldi.

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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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