Catheter ablation of postinfarction ventricular tachycardia: Ten-year trends in utilization, in-hospital complications, and in-hospital mortality in the United States Chandrasekar Palaniswamy, MD, * Dhaval Kolte, MD, PhD, * Prakash Harikrishnan, MD, * Sahil Khera, MD, * Wilbert S. Aronow, MD, * Marjan Mujib, MD, MPH, * William Michael Mellana, MD, * Paul Eugenio, MD, * Seth Lessner, MD, * Aileen Ferrick, PhD, FHRS, * Gregg C. Fonarow, MD, † Ali Ahmed, MD, ‡ Howard A. Cooper, MD, * William H. Frishman, MD, * Julio A. Panza, MD, * Sei Iwai, MD, FHRS * From the * Department of Medicine, Division of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, New York, † David Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles, California, and ‡ University of Alabama at Birmingham and VA Medical Center, Birmingham, Alabama. BACKGROUND There is a paucity of data regarding the complica- tions and in-hospital mortality after catheter ablation for ventric- ular tachycardia (VT) in patients with ischemic heart disease. OBJECTIVE The purpose of this study was to determine the temporal trends in utilization, in-hospital mortality, and complications of catheter ablation of postinfarction VT in the United States. METHODS We used the 2002–2011 Nationwide Inpatient Sample (NIS) database to identify all patients Z18 years of age with a primary diagnosis of VT (International Classification of Diseases, Ninth Edition, Clinical Modification [ICD-9-CM] code 427.1) and who also had a secondary diagnosis of prior history of myocardial infarction (ICD-9-CM 412). Patients with supraventricular arrhyth- mias were excluded. Patients who underwent catheter ablation were identified using ICD-9-CM procedure code 37.34. Temporal trends in catheter ablation, in-hospital complications, and in-hospital mor- tality were analyzed. RESULTS Of 81,539 patients with postinfarct VT, 4653 (5.7%) underwent catheter ablation. Utilization of catheter ablation increased significantly from 2.8% in 2002 to 10.8% in 2011 (P trend o .001). The overall rate of any in-hospital complication was 11.2% (523/4653), with vascular complications in 6.9%, cardiac in 4.3%, and neurologic in 0.5%. In-hospital mortality was 1.6% (75/ 4653). From 2002 to 2011, there was no significant change in the overall complication rates (8.4% to 10.2%, P trend ¼ .101; adjusted odds ratio [per year] 1.02, 95% confidence interval 0.98–1.06) or in-hospital mortality (1.3% to 1.8%, P trend ¼ .266; adjusted odds ratio [per year] 1.03, 95% confidence interval 0.92–1.15). CONCLUSION The utilization rate of catheter ablation as therapy for postinfarct VT has steadily increased over the past decade. However, procedural complication rates and in-hospital mortality have not changed significantly during this period. KEYWORDS Catheter ablation; Outcomes; Registry; Trends; Ventricular tachycardia ABBREVIATIONS CI ¼ confidence interval; HCUP ¼ Healthcare Cost and Utilization Project; ICD ¼ implantable cardioverter- defibrillator; ICD-9-CM ¼ International Classification of Diseases, Ninth Edition, Clinical Modification; MI ¼ myocardial infarction; NIS ¼ Nationwide Inpatient Sample; OR ¼ odds ratio; VT ¼ ventricular tachycardia (Heart Rhythm 2014;11:2056–2063) I 2014 Heart Rhythm Society. All rights reserved. Introduction Sudden cardiac death accounts for 350,000 to 380,000 deaths annually in the United States. 1 Ventricular tachyarrhythmia leading to electrical and hemodynamic instability is the predominant mechanism underlying sudden cardiac death. Ventricular tachycardia (VT) commonly develops in patients with structural heart disease. In patients with prior myocardial infarction (MI), heterogeneity in scar formation alters impulse propagation, facilitating reentry resulting in monomorphic Drs. Palaniswamy, Kolte, Harikrishnan, and Khera contributed equally to this study. Dr. Iwai is on a Safety and Data Monitoring Board for Biotronik. Dr. Fonarow has served as a consultant for Medtronic. This study was presented at the American College of Cardiology 63rd Scientific Sessions as an oral contribution in the “Joint Session of the Heart Rhythm Society and the American College of Cardiology: Year in Review” Session in Washington, DC, on March 30, 2014. Address reprint requests and correspondence: Dr. Sei Iwai, Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, 100 Woods Rd, Macy Pavilion 111, Valhalla, NY 10595. E-mail address: iwais@wcmc.com. 1547-5271/$-see front matter B 2014 Heart Rhythm Society. All rights reserved. http://dx.doi.org/10.1016/j.hrthm.2014.07.012