Incidence of ventricular arrhythmias in patients with chronic total coronary occlusion: Results of the VACTOR study

Amira Assaf, Rafi Sakhi, Roberto Diletti, Alexander Hirsch, Cornelis P Allaart, Rohit Bhagwandien, Mehran Firouzi, Pieter C Smits, Mark G Hoogendijk, Dominic A M J Theuns, Sing-Chien Yap, Amira Assaf, Rafi Sakhi, Roberto Diletti, Alexander Hirsch, Cornelis P Allaart, Rohit Bhagwandien, Mehran Firouzi, Pieter C Smits, Mark G Hoogendijk, Dominic A M J Theuns, Sing-Chien Yap

Abstract

Background: A chronic total coronary occlusion (CTO) is associated with ventricular arrhythmias (VA) in patients with an implantable cardioverter-defibrillator (ICD). Limited data is available on the incidence of VA in CTO patients without an ICD.

Objectives: To investigate the incidence of sustained VA in CTO patients after successful CTO revascularization and in patients with untreated CTO or failed CTO revascularization.

Methods: Prospective, multicenter observational pilot study including CTO patients who were not eligible for an ICD and had a left ventricular ejection fraction >35 %. We enrolled patients with a successful CTO revascularization (group A) and patients with untreated CTO or failed CTO revascularization (group B). All patients received an implantable loop recorder with remote monitoring. The primary endpoint was sustained VA.

Results: Ninety patients were enrolled (mean age 63 ± 10 years, 83.3 % man, mean LVEF 55 ± 8 %). Group A (n = 45) had a higher prevalence of CTO in the left anterior descending artery in comparison to group B (n = 45) (28.9 % versus 4.4 %, P = 0.002). Other baseline characteristics were similar. During a median follow-up time of 26 months (IQR, 19-35), five patients (5.6 %) had a sustained VA. There was no difference in the incidence of sustained VA between groups (3-year cumulative event rate: 8.8 % (group A) versus 4.5 % (Group B), log-rank P = 0.71).

Conclusion: Patients with an CTO, who do not qualify for an ICD, have a substantial risk of sustained VA. In our study the incidence was not different between patients with revascularized and those with untreated CTO.

Keywords: Chronic total coronary occlusion; Implantable cardioverter-defibrillator; Myocardial infarction; Percutaneous coronary intervention; Sudden cardiac death; Ventricular arrhythmia.

Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: SCY has received consultancy and speaker fees from Boston Scientific, and institutional research grants from Medtronic, Biotronik and Boston Scientific. The other authors have nothing to declare.

© 2023 The Authors.

Figures

Fig. 1
Fig. 1
Screening and inclusion of patients in the VACTOR study.
Fig. 2
Fig. 2
(A) Comparison of the cumulative event rate of sustained VT or VF between patients with revascularized CTO and patients with untreated CTO. (B) Comparison of the cumulative MACE-free survival rate between patients with revascularized CTO and patients with untreated CTO. (C) Comparison of the cumulative survival rate between patients with revascularized CTO and patients with untreated CTO. (D) Comparison of the cumulative event rate of actionable events between patients with revascularized CTO and patients with untreated CTO.
Fig. 3
Fig. 3
ILR-registration of the primary endpoint per patient.

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