Catheter ablation for the treatment of ventricular arrhythmias in the early phase following acute coronary syndrome

Abstract Background Ventricular arrhythmias (VAs) are life-threatening cardiac conditions that frequently arise in the early phases following acute coronary syndrome (ACS). Catheter ablation (CA) has emerged as a crucial intervention for managing these patients; however, the timing, safety and efficacy of this procedure in the acute setting of coronary syndromes remain inadequately understood. Purpose Thereby we sought to investigate the short- and long-term outcomes of incessant drug-refractory VAs catheter ablation in the early post-ACS setting in a large series of consecutive patients. The objective is to enhance clinical decision-making and optimize treatment protocols in a high-risk patient population, improving prognostic outcomes. Methods We conducted a retrospective multi-center cohort study, enrolling 148 patients from various locations across Europe and North America who underwent catheter ablation for drug-refractory ventricular arrhythmias within 30 days following acute coronary syndrome (ACS). Results Our cohort had an average age of 63.8 ± 10.7 years. VA occurred in the vast majority of patients with ST-elevation myocardial infarction (109, 73.6%) and severely compromised left ventricular ejection fraction (LVEF). The first arrhythmic episode occurred 9.2 ± 7.1 days after ACS, with most episodes being monomorphic ventricular tachycardias (VTs). Catheter ablation was performed an average of 4.3 ± 6.4 days after the arrhythmic episode. Acute success of catheter ablation was obtained in the 70% while complications were reported in only 12.8% (19) of cases. Among the 103 successful procedures, 20 patients experienced early recurrence during hospitalization, of whom eight underwent a second ablation, resulting in two fatalities. Of the twelve patients who did not undergo a repeat ablation, eight died. Among the remaining 45 procedures, 12 patients had recurrent arrhythmias. The complications included cardiac tamponade (4, 2.7%), left ventricular perforation (1, 1.3%), atrioventricular block (AVB) (6, 4.1%), and vascular complications (3, 2.0%). In total, 30 patients (20.2%) died during hospitalization. In the long-term follow-up after discharge, 12 patients experienced a recurrence, with four requiring another ablation. Discussion In this international, multi-center, retrospective study of ventricular arrhythmias in the early phase following acute coronary syndrome (ACS), catheter ablation was demonstrated to be a relatively effective procedure. However, patients who experienced secondary arrhythmias without undergoing repeat ablation appeared to have an increased mortality risk.In-Hospital Follow-Up