Introduction:
Catheter radiofrequency ablation (RFA) is used increasingly for treatment of ventricular tachycardia (VT), but little is known about utilization patterns.
Hypothesis:
Regional trends in VT hospitalization and RFA,and patient characteristics associated with VT RFA vary.
Methods:
Hospital discharge data was obtained from state agencies in California, New York, New Jersey, Vermont, New Hampshire, West Virginia, Colorado, and Texas from 1994-2012. All records with primary diagnosis of VT (ICD9-CM 427.1) were analyzed. Population-adjusted hospitalization rates were estimated using US Census Bureau data. In hospitals performing VT RFA, patient characteristics associated with RFA were identified using multivariate logistic regression.
Results:
In total, 184,443 hospitalizations for VT were reported; 11,941/136,437 (8.8%) admitted to VT ablation hospitals underwent RFA. Annual VT hospitalization rates varied from 10-17/100,000 in California (CA) and Texas (TX) to 20-30 in New York and New Jersey (NJ). VT ablation/hospitalization frequency varied from 9% in NJ to 18% in CA and TX. Positive predictors of undergoing VT RFA were female gender, non-white race, admission from home, and atrial flutter. Negative predictors included advancing age, non-private insurance, atrial fibrillation, anemia, coronary artery disease, heart failure, hypertension, and shock on admission (Figure, A). Higher RFA rates for women were driven by more patients without structural heart disease compared to men (Figure, B). Non-white patients were more likely to undergo RFA irrespective of structural heart disease.
Conclusion:
Significant regional variations exist in VT hospitalization and ablation rates. Also of note, women and non-white patients were more likely to undergo ablation, which may have reflected important differences in cardiac disease substrate.
Ventricular Tachycardia Isthmus Characteristics: Insights from High-density Mapping