Introduction: Ventricular tachycardia (VT) is a potentially life-threatening arrhythmia that can be caused by many factors, such as the patients’ underlying cardiac condition and importantly the cardiac scar. However, initiation of VT can be multi-factorial, and be associated with other factors, such as lifestyle, glycaemic control and respiratory disease. An implantable cardioverter defibrillator (ICD) is used to treat VT, and medical therapy is utilised to reduce the burden of VT. We established a multi-disciplinary (MDT) VT clinic in 2018 and proved a reduction of ICD therapy for VT. Following the appointment of a new consultant supervising VT clinic, we aimed to re-evaluate the effect on the clinic. Comparing the total device burden of therapies delivered 6 months before the VT clinic appointment and 6 months after the initial clinic appointment.
Methods: A retrospective service evaluation was conducted at a tertiary cardiac centre between April 2021 and April 2022. The population included all new patients over the age of 18 who were managed under the new VT clinic supervision between April 2021 and April 2022. Results: Within the study cohort of 69 patients, shocks pre- and post-clinic demonstrated an odds ratio of 18.79 (95% CI 6.31 to 51.49, p=<0.0001) and anti-tachycardia pacing pre- and post-clinic shows an odds ratio of 17.37 (95% CI 6.43 to 44.03, p=<0.0001). Medical management device optimization was the most common therapy occurring in 75% of patients, with 4% being referred for VT ablation and 17% having no changes in their management. Anti-arrhythmic medication, beta blockers or class III antiarrhythmic, up-titration was performed in 45% of patients. Device optimization performed in 29%. Initiation of Class III antiarrhythmic was performed in 6% of patients. Heart failure medical optimization or drug initiation (ACE inhibitor, ARB, MRA, SGLT2i or Entresto) was performed in 13%. Referral to advanced heart failure care or to specialist cardiomyopathy EP was the outcome for 7%. Twenty-nine per cent of patients had more than one clinic outcome. Regarding the patient-pathway timeline, 48% of patients were seen in clinic between 1–15 days, the remaining 36 patients were seen between 16 to 120 days, with a mean of 27 days.
Conclusion: The service evaluation demonstrated a significant reduction in ICD therapy burden, with medical management and device optimization being the most common clinical outcomes. The use of other methodologies is likely to have contributed to the patient’s overall health and likely been a factor in the large reduction of VT burden across the cohort. The results indicate that holistic approaches can significantly reduce the burden of VT, utilising an individualised care plan. Further investigation into the patient-reported outcome measures from this clinic of VT can build to the developing evidence for management of patients with VT. ❑
Figure 1: Bar graph showing the significant reduction of ATP and shock therapy pre- and post-VT clinic (p=<0.0001)
