Utilization and Complications of Catheter Ablation for Ventricular Arrhythmia in Patients with Mechanical Valves

Background: Catheter ablation (CA) for ventricular arrhythmias (VAs) is increasingly utilized in the recent years. Ablation for VAs in patients with mechanical valves (MVs), can be challenging due to the chronic anticoagulation therapy, limitations in accessing the left ventricle, the risk for entrapment of mapping or ablation catheters between the leaflets of MVs and more. Objective: To investigate the nationwide trends in utilization and complications of CA for VAs in patients with prior MVs.

Methods: We drew data from the US National Inpatient Sample database to identify cases of VA ablations in patients with MVs between 2003 and 2015. Sociodemographic and clinical data were collected, and incidence of catheter ablation complications, mortality, and length of stay were analyzed. We compared the outcomes to a propensity matched cohort of patients without prior valve surgery.

Results: The study population included a weighted total of 647 CA cases in patients with prior MVs patients. The annual number of ablations almost doubled during the “late years” (2009-2015) compared to the "early years" (2003-2008) of the study (p=0.001). Length of stay at hospital was not different among patients with MVs and 649 matched patients without prior MVs (5.4 ± 0.4, 4.7 ± 0.3 days respectively, p=0.12). The complication rate was not significantly different between patients with and without MVs (12.6% vs. 7.5% respectively, p=0.14). There was a trend toward higher mortality among patients with MVs undergoing CA compared to matched patients without MVs (3.7% vs. 0.7% respectively, p=0.087) which did not reach statistical significance.

Conclusion: The volume of CAs for VAs in patients with MVs increased substantially over the years. The data shows a trend towards increased incidence of morality and complications in the study population, requiring further investigation in larger population cohort.