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Impact of a multidisciplinary approach in ventricular tachycardia ablation complication rate: team work to improve outcomes
Session:
Posters (Sessão 4 - Écran 4) - Taquicardia ventricular e morte súbita cardíaca
Speaker:
Joana Brito
Congress:
CPC 2023
Topic:
C. Arrhythmias and Device Therapy
Theme:
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme:
08.7 Ventricular Arrhythmias and SCD - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Joana Brito; Afonso Nunes Ferreira; Pedro Alves da Silva; Beatriz Garcia; Beatriz Valente Silva; Catarina Oliveira; Sara Neto; Gustavo Lima da Silva; Luís Carpinteiro; Nuno Cortez-Dias; Fausto J. Pinto; João de Sousa
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong>: Radiofrequency ablation of structural ventricular tachycardia (VT) are complex procedures performed in a high-risk group of patients (pts); this unfortunately leads to a considerable risk of procedural complications. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Aim:</strong> To evaluate the impact of the implementation of a multidisciplinary approach, with intensive management by a cardiac anesthesiologist and including the use of general anesthesia, in the safety of VT ablation.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> Single-center study of pts with structural heart disease submitted to VT ablation from 2019 to 2022. After April.2021, all procedures were performed with the participation of a cardiac anesthesiologist in the medical team. Before, procedures were conducted under conscious sedation, with invasive blood pressure monitoring and hemodynamic management by the electrophysiologist team. Procedural complications, either minor or severe, were prospectively assessed. Severe complications were defined as the occurrence of death, systemic embolism, stroke, cardiogenic shock, or cardiac tamponade. The impact of adopting a multidisciplinary approach in the risk of procedural complications was determined using univariate regression analysis.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Results</span></strong><span style="color:black">: </span>A total of 68 patients were submitted to VT ablation, 34 with and 34 without a multidisciplinary management approach. About 96% were males, mean age was 66±11yo, 66% had ischemic heart disease and mean LVEF was 34±11%. The two groups were indistinct regarding the demographic and clinical characteristics. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Procedural complications occurred in 10 pts (14.7%), being severe in 4 (5.9%). The adoption of a multidisciplinary management approach was associated with an 8-fold reduction in the risk of procedural complications (odds ratio: 8.5; <span style="color:black">95%CI 1.02-70.7; </span>p=0.048). Noticeably, no severe complications occurred in the group treated with anesthetic support and it was possible to suspend the hemodynamic and invasive respiratory assistance in all pts at the end of the ablation procedure.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Conclusions:</span></strong> The adoption of a multidisciplinary approach, with intensive management by a cardiac anesthesiologist and including the use of general anesthesia, is highly beneficial, reducing the risk of <span style="color:black">procedural complications.</span></span></span></p>
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