Predictors of Permanent Pacemaker Implantation in Patients With Severe Aortic Stenosis Undergoing TAVR : A Meta-Analysis

Background

Atrioventricular (AV) conduction disturbances requiring permanent pacemaker (PPM) implantation may complicate transcatheter aortic valve replacement (TAVR). Available evidence on predictors of PPM is sparse and derived from small studies.

Objectives

The objective of this study was to provide summary effect estimates for clinically useful predictors of PPM implantation after TAVR.

Methods

We performed a systematic search for studies that reported the incidence of PPM implantation after TAVR and that provided raw data for the predictors of interest. Data on study, patient, and procedural characteristics were abstracted. Crude risk ratios (RRs) and 95% confidence intervals for each predictor were calculated by use of random effects models. Stratified analyses by type of implanted valve were performed.

Results

We obtained data from 41 studies that included 11,210 TAVR patients, of whom 17% required PPM implantation after intervention. The rate of PPM ranged from 2% to 51% in individual studies (with a median of 28% for the Medtronic CoreValve Revalving System [MCRS] and 6% for the Edwards SAPIEN valve [ESV]). The summary estimates indicated increased risk of PPM after TAVR for men (RR: 1.23; p < 0.01); for patients with first-degree AV block (RR: 1.52; p < 0.01), left anterior hemiblock (RR: 1.62; p < 0.01), or right bundle branch block (RR: 2.89; p < 0.01) at baseline; and for patients with intraprocedural AV block (RR: 3.49; p < 0.01). These variables remained significant predictors when only patients treated with the MCRS bioprosthesis were considered. The data for ESV were limited. Unadjusted estimates indicated a 2.5-fold higher risk for PPM implantation for patients who received the MCRS than for those who received the ESV.

Conclusions

Male sex, baseline conduction disturbances, and intraprocedural AV block emerged as predictors of PPM implantation after TAVR. This study provides useful tools to identify high-risk patients and to guide clinical decision making before and after intervention.     

Diagnostic accuracy of computer-assisted electrocardiography in the diagnosis of left ventricular hypertrophy in left bundle branch block

Introduction and objectives

Left ventricular hypertrophy has important prognostic implications. Although electrocardiography is the technique most often recommended in the diagnosis of hypertrophy, its diagnostic accuracy is hampered in the presence of a left bundle branch block.

Methods

In 1875 consecutive patients (56±16 years) undergoing studies to rule out heart disease and/or hypertension, 2-dimensional echocardiography and electrocardiography were performed simultaneously in an outpatient clinic. Digitized electrocardiograms were interpreted using an online computer-assisted platform (ELECTROPRES). Sensitivity, specificity, likelihood ratios, and predictive values of standard electrocardiographic criteria and of some diagnostic algorithms for left ventricular hypertrophy were determined and compared with the findings in patients with neither left bundle branch block nor myocardial infarction.

Results

Left bundle branch block was present in 233 (12%) patients. Left ventricular hypertrophy was detected more frequently in patients with left bundle branch block (60% vs 31%). In patients with left bundle branch block, sensitivities were low but similar to those observed in patients without it, and ranged from 6.4% to 70.9%, whereas specificities were high, ranging from 57.6% to 100%. Positive likelihood ratios ranged from 1.33 to 4.94, and negative likelihood ratios from 0.50 to 0.98. Diagnostic algorithms, voltage-duration products, and certain compound criteria had the best sensitivities.

Conclusions

Left ventricular hypertrophy can be diagnosed in the presence of left bundle branch block with an accuracy at least similar to that observed in patients without this conduction defect. Computer-assisted interpretation of the electrocardiogram may be useful in the diagnosis of left ventricular hypertrophy as it enables the implementation of more accurate algorithms.Full English text available from:www.revespcardiol.org     

Predictors of Advanced His-Purkinje Conduction Disturbances in Patients With Unexplained Syncope and Bundle Branch Block

Background

For patients presenting with syncope and bundle branch block (BBB), results during electrophysiological studies (EPS) might depend on the electrocardiographic pattern of conduction disturbances. We sought to identify predictors of advanced His-Purkinje conduction disturbances (HPCDs) in these patients.

Methods

In this retrospective multicentre study, patients were included who: (1) presented with unexplained syncope; (2) had BBB (QRS duration ≥ 120 ms); and (3) were investigated with EPS. HPCD was diagnosed if the baseline His-ventricular interval was ≥ 70 ms or if second- or third-degree His-Purkinje block was observed during atrial pacing or pharmacological challenge.

Results

Of the 171 patients studied (72 ± 13 years, 64% male sex, mean left ventricular ejection fraction 57 ± 9%), advanced HPCD was found in 73 patients (43%). The following electrocardiographic features were associated with HPCD (P = 0.01): isolated right BBB (34.4%), right BBB with left anterior fascicular block (36.4%), left BBB (46.2%), and right BBB with left posterior fascicular block (LPFB, 78.6%). Multivariate analysis identified first-degree atrioventricular block (odds ratio, 2.4; 95% confidence interval, 1.2-4.7; P = 0.01) and LPFB (odds ratio, 4.8; 95% confidence interval, 1.3-18.5; P = 0.02) as the only 2 independent predictors of advanced HPCD.

Conclusions

For patients presenting with syncope and BBB, first-degree atrioventricular block and LPFB increased the likelihood of finding HPCDs during EPS. However, no single electrocardiographic feature could consistently predict the outcome of EPS, so this investigation is still necessary in assessing the need for pacemaker implantation, irrespective of the precise appearance of abnormalities on ECG.     

Electrocardiographic abnormalities in the first year after heart transplantation

Study Aim

Describe ECG abnormalities in the first year following transplant surgery.

Methods

Analysis of 12-lead ECGs from heart transplant subjects enrolled in an ongoing multicenter clinical trial.

Results

585 ECGs from 98 subjects showed few with abnormal cardiac rhythm (99% of ECGs were sinus rhythm/tachycardia). A majority of subjects (69%) had either right intraventricular conduction delay (56%) or right bundle branch block (13%). A second prevalent ECG abnormality was atrial enlargement (64% of subjects) that was more commonly left atrial (55%) than right (30%).

Conclusions

Right intraventricular conduction delay or right bundle branch block is prevalent in heart transplant recipients in the first year following transplant surgery. Whether this abnormality is related to acute allograph rejection or endomyocardial biopsy procedures is the subject of the ongoing clinical trial. Atrial enlargement ECG criteria (especially, left atrial) are also common and are likely due to transplant surgery with subsequent atrial remodeling.     

Incidence and Predictors of Late Complete Heart Block After Alcohol Septal Ablation Treatment of Hypertrophic Obstructive Cardiomyopathy

Objectives

This study was designed to identify the incidence of late complete heart block (CHB) first identified at least 48 hours post alcohol septal ablation (ASA).

Background

Septal reduction with ASA is a therapeutic option for patients with symptomatic hypertrophic obstructive cardiomyopathy (HCM). CHB, resulting from the septal infarct, is a known complication with a reported incidence of 9–22%. The incidence of CHB more than 48 hours post‐procedure is unknown.

Methods

Consecutive patients who underwent ASA were analyzed and clinical characteristics associated with late CHB were assessed. Late CHB was defined as first identification of CHB more than 48 hours after ASA.

Results

From 2002–2013, 145 subjects underwent 168 ASA procedures and were followed for a mean of 3.2 +/? 2.3 years. The incidence of late CHB was 8.9% (15/168 ASA procedures). Heart block occurred from 48 hours to 3‐years post‐procedure. In a multivariable model, patients with any CHB were more likely to have had multiple ASA procedures (OR 4.14; 95% CI: 1.24, 13.9; P < 0.05) and high resting and provoked left ventricular outflow tract (LVOT) gradient assessed by catheterization (OR per 10 mmHg gradient 1.14; 95% CI: 1.0, 1.20; P < 0.05). After multivariable adjustment, only a high provokable LVOT gradient remained an independent predictor of late CHB (OR per 10 mmHg gradient 1.14 [95% CI 1.02–1.29]).

Conclusions

Late CHB is a common complication of ASA for treatment of symptomatic HCM. Post‐discharge electrocardiographic surveillance for atrioventricular conduction disease should be considered after ASA, especially for those with a high provokable LVOT gradient. (J Interven Cardiol 2015;28:90–97)

     

Prehospital ECG signs of acute coronary occlusion are associated with reduced one-year mortality

Background

We wanted to evaluate predictors of direct admittance to a coronary care unit (CCU) and predictors of death in patients with suspected acute coronary syndromes (ACS).

Methods

During 2004–2007, all consecutive prehospitally triaged patients with suspected ACS were prospectively included. Prehospital and emergency data were collected at point of care. Data from medical records, ECG-, echocardiography- and laboratory databases was collected retrospectively.

Results

In all, 2757 patients were included. Out of these 858 were directly admitted to the CCU or cath/lab.Predictors for direct admittance to the CCU were ST-segment elevation on the initial ECG; odds ratio (OR) 46.11, left bundle branch block; OR 3.30, ongoing symptoms; OR 2.90, current smoking; OR 2.18 and ST-segment depression; OR 2.05.Independent predictors for 1-year mortality were cardiogenic shock; OR 14.40, increasing age OR (per year) 1.08, diabetes; OR 2.09 and chronic heart failure; OR 1.67.ST-segment elevation was associated with a lower 1-year mortality rate; OR 0.52.

Conclusions

Among patients with a suspected ACS, prehospital ECG-signs indicating an acute coronary occlusion were not only a predictor for direct admission to acute coronary care but also a predictor for increased survival. To improve future outcome in acute ischemic heart diseases we must find and treat not only the STEMI's but also the high-risk NSTEMIs that otherwise would have a poor prognosis.     

Predictors of Advanced Conduction Disturbances Requiring a Late (≥48 H) Permanent Pacemaker Following Transcatheter Aortic Valve Replacement

Objectives

This study sought to determine predictors of advanced conduction disturbances requiring late (≥48 h) permanent pacemaker replacement (PPM) after transcatheter aortic valve replacement (TAVR).

Pacemaker dependency after transcatheter aortic valve implantation with the self-expanding Medtronic CoreValve System

Background/objectives

To determine pacemaker (PM) dependency at follow-up visit in patients who underwent new permanent pacemaker implantation (PPI) following transcatheter aortic valve implantation (TAVI).

Methods

Single center prospective observational study including 167 patients without previous PM implantation who underwent TAVI with the self-expanding Medtronic CoreValve System (MCS) between November 2005 and February 2011. PM dependency was defined by the presence of a high degree atrioventricular block (HDAVB; second [AV2] and third degree [AV3B]), or a slow (< 30 bpm) or absent ventricular escape rhythm during follow-up PM interrogation.

Results

A total of 36 patients (21.6%) received a new PM following TAVI. The indication for PM was AV2B (n = 2, 5.6%), AV3B (n = 28, 77.8%), postoperative symptomatic bradycardia (n = 3, 8.3%), brady–tachy syndrome (n = 1, 2.8%), atrial fibrilation with slow response (n = 1, 2.8%) and left bundle branch block (n = 1, 2.8%). Long term follow-up was complete for all patients and ranged from 1 to 40 months (median (IQR): 11.5 (5.0–18.0 months). Of those patients with a HDAVB, 16 out of the 30 patients (53.3%) were PM independent at follow-up visit (complete or partial resolution of the AV conduction abnormality). Overall, 20 out of the 36 patients (55.6%) who received a new PM following TAVI were PM independent at follow-up.

Conclusion

Partial and even complete resolution of peri-operative AV conduction abnormalities after MCS valve implantation occurred in more than half of the patients.     

Conduction abnormalities post alcohol septal ablation for hypertrophic cardiomyopathy – A single center experience

Conduction abnormalities are commonly noted after alcohol septal ablation (ASA). This was a retrospective, observational study where we studied the incidence of new onset conduction abnormalities post ASA. 23 patients, who underwent ASA over a period of 5 years, were included in the study. Baseline conduction abnormalities were noted in 26% patients (n = 6). Transient complete heart block (CHB) was noted in 21.7% (n = 5) whereas new onset right bundle branch block (RBBB) was seen in 60.8% (n = 14). Left bundle branch block was uncommon (4.3%,n = 1). Permanent pacemaker implantation was done in 4.3% (n = 1) for CHB. Conduction anomalies are frequent after ASA with RBBB being most common.     

Prognostic significance of the absence of normal septal Q waves before aortic valve replacement

Purpose

Aim of this study was to investigate the prognostic significance of absence of septal Q waves in patients scheduled for aortic valve replacement.

Material and Methods

Sixty-one patients who underwent isolated aortic valve replacement for aortic stenosis were retrospectively evaluated. Septal Q waves were defined as Q waves of < 2 mm in amplitude and < 40 ms in width and absence of septal Q waves was defined as simultaneous loss of Q waves from at least three of the leads I, aVL, V5 and V6. Septal Q waves were absent in 17 patients (Group AQ, 27.8%) and were present in 44 patients (Group PQ, 72.1 %) preoperatively. Newly developed AV block > 1st degree and newly developed left bundle branch block were primary endpoints.

Results

Preoperatively, absence of normal septal Q waves was significantly associated with increased risk of postoperative AV block (HR: 11.18, range 1.37–91.21, 95% CI, p = 0.02) whereas it was not associated with increased risk for newly developed LBBB (HR: 3.15 0.62–15.83, 95% CI, p = 0.16).

Conclusion

Absence of normal septal Q waves in the preoperative ECG may predict further delay in conduction which might develop in the early postoperative course of aortic valve replacement.     

Immediate Post-Procedural 12-Lead Electrocardiography as Predictor of Late Conduction Defects After Transcatheter Aortic Valve Replacement

Objectives

The aim of this study was to use a 12-lead electrocardiogram obtained immediately post–transcatheter aortic valve replacement (TAVR) to identify predictors of late high-degree conduction defect (HD-CD) within 30 days after TAVR.

Survival of Patients ≤ 50 Years of Age After Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy

Background

The long-term efficacy and safety of alcohol septal ablation (ASA) has recently been demonstrated. However, there is still debate about the outcome of younger patients who should be treated using myectomy, according to American College of Cardiology Foundation/American Heart Association guidelines. The aim of this study was to evaluate the long-term outcome of patients ≤ 50 years of age after ASA for hypertrophic obstructive cardiomyopathy (HOCM).

Methods

We retrospectively evaluated consecutive, highly symptomatic patients aged ≤ 50 years with HOCM who underwent ASA.

Results

Institutional databases of 3 cardiovascular centres identified 290 patients with HOCM who underwent ASA; 75 (26%) of them were aged ≤ 50 years at the time of their first ASA. Median duration of follow-up was 5.1 years (range, 0.1-15.4 years). Four patients (5%) died during the study period (438 patient-years; the annual mortality rate was 0.91%; 95% confidence interval [CI], 0.25-2.34%; the annual mortality rate combined with the first appropriate implantable cardioverter-defibrillator discharge was 1.43%; 95% CI, 0.52-3.10%). Survival free of all-cause mortality at 1, 5, and 10 years was 97% (95% CI, 89-99%), 94% (95% CI, 84-98%), and 94% (95% CI, 84-98%), respectively.

Conclusions

Results of this first study focused on HOCM patients aged ≤ 50 years who underwent ASA suggest a low risk of all-cause death or appropriate implantable cardioverter-defibrillator discharge in the long-term follow-up.     

Prevalence of ventricular conduction blocks in the resting electrocardiogram in a general population: The Health 2000 Survey

Aims

The prevalence of eight different ventricular conduction blocks and their association with risk factors and major cardiovascular diseases were studied in a major Finnish population study.

Methods

Data, including 12-lead electrocardiograms, were collected from 6315 subjects. The prevalence of left bundle branch block (LBBB), right bundle branch block (RBBB), non-specific ventricular block, incomplete LBBB, incomplete RBBB, R–R′-pattern, left anterior hemiblock (LAHB), and left posterior hemiblock (LPHB) was calculated for both genders in three age groups. Their association with risk factors and cardiovascular diseases was studied.

Results

R–R′-pattern was the most common ventricular conduction block in all age groups (3.9%, p < 0.001 for comparison between groups), but it showed no association with cardiovascular diseases. Males had more RBBB (1.5% vs. 0.7%, p < 0.001), incomplete LBBB (1.8 vs. 0.4, p < 0.001) and non-specific ventricular block (1.1% vs. 0.1%, p < 0.001).With increasing age (< 45 years vs. > 55 years) LBBB, RBBB and LAHB (0 vs. 2.2%, 0.3 vs. 2.2%, 0.2 vs. 1.9% respectively, p-values < 0.001) became more prevalent. LBBB, RBBB and non-specific ventricular conduction block were associated with coronary heart disease (angina pectoris in 28.3, 20.3 and 22.9%, respectively) and heart failure (25.0, 10.1 and 11.4%, respectively). LBBB and RBBB were also associated with peripheral vascular disease (8.8%).

Conclusions

Ventricular conduction blocks differ in prevalence between sexes and age groups. They also show disparate association with cardiovascular diseases. These differences need to be taken into consideration in everyday clinical practice.     

Acute predictors of subacute complete heart block after alcohol septal ablation for obstructive hypertrophic cardiomyopathy

Acute and subacute complete heart block (CHB) are sequelae of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy. Temporary pacemakers are routinely placed at the time of ASA, but there are no widely accepted guidelines for their management. This study examined acute predictors of subacute CHB in 52 consecutive ASA procedures in 48 patients without preexisting permanent pacemakers. Acute CHB occurred during 32 ASA procedures (62%), with the return of atrioventricular conduction on the day of ASA in all cases. New intraventricular conduction defects (IVCDs) were noted after 32 procedures (62%); in 9 of these, there was new first-degree atrioventricular block as well. CHB recurred subacutely 36 +/- 22 hours after 13 ASA procedures (25%). In 5 of these cases, there was absent or inconsistent ventricular escape rhythm. Subacute CHB did not occur in 9 cases without acute CHB during ASA or new IVCDs after ASA. Acute CHB during ASA, new IVCDs after ASA, and new first-degree atrioventricular block after ASA incrementally increased the risk for subacute CHB. In conclusion, patients with acute CHB during ASA or new IVCDs after ASA are at high risk for developing subacute CHB, sometimes without a reliable escape rhythm; these patients should therefore have temporary pacing support for > or = 48 hours after ASA or the last occurrence of CHB. Patients without acute CHB during ASA or new IVCDs after ASA are at low risk for subacute CHB.     

QRS analysis using wavelet transformation for the prediction of response to cardiac resynchronization therapy: A prospective pilot study

Background

Wider QRS and left bundle branch block morphology are related to response to cardiac resynchronization therapy (CRT). A novel time-frequency analysis of the QRS complex may provide additional information in predicting response to CRT.

Methods

Signal-averaged electrocardiograms were prospectively recorded, before CRT, in orthogonal leads and QRS decomposition in three frequency bands was performed using the Morlet wavelet transformation.

Results

Thirty eight patients (age 65 ± 10 years, 31 males) were studied. CRT responders (n = 28) had wider baseline QRS compared to non-responders and lower QRS energies in all frequency bands. The combination of QRS duration and mean energy in the high frequency band had the best predicting ability (AUC 0.833, 95%CI 0.705-0.962, p = 0.002) followed by the maximum energy in the high frequency band (AUC 0.811, 95%CI 0.663-0.960, p = 0.004).

Conclusions

Wavelet transformation of the QRS complex is useful in predicting response to CRT.     

Integration of Mechanical,Structural and Electrical Imaging to Understand Response to Cardiac Resynchronization Therapy

Introduction and objectives

There is extensive controversy exists on whether cardiac resynchronization therapy corrects electrical or mechanical asynchrony. The aim of this study was to determine if there is a correlation between electrical and mechanical sequences and if myocardial scar has any relevant impact.

Methods

Six patients with normal left ventricular function and 12 patients with left ventricular dysfunction and left bundle branch block, treated with cardiac resynchronization therapy, were studied. Real-time three-dimensional echocardiography and electroanatomical mapping were performed in all patients and, where applicable, before and after therapy. Magnetic resonance was performed for evaluation of myocardial scar. Images were postprocessed and mechanical and electrical activation sequences were defined and time differences between the first and last ventricular segment to be activated were determined. Response to therapy was defined as a reduction in left ventricular end-systolic volume ≥ 15% after 12 months of follow-up.

Results

Good correlation between electrical and mechanical timings was found in patients with normal left ventricular function (r² = 0.88; P = .005) but not in those with left ventricular dysfunction (r² = 0.02; P = not significant). After therapy, both timings and sequences were modified and improved, except in those with myocardial scar.

Conclusions

Despite a close electromechanical relationship in normal left ventricular function, there is no significant correlation in patients with dysfunction. Although resynchronization therapy improves this correlation, the changes in electrical activation may not yield similar changes in left ventricular mechanics particularly depending on the underlying myocardial substrate.     

A larger vectorcardiographic QRS area is associated with left bundle branch block and good prognosis in patients with cardiac resynchronization therapy

Background

The association between the vectorcardiographic QRS area, bundle branch pattern and clinical long-term prognosis in patients who have undergone cardiac resynchronization therapy (CRT) has been unclear.

Left bundle branch block and the evolving role of QRS morphology in selection of patients for cardiac resynchronization

Background

The clinical significance of left bundle branch block (LBBB) has recently expanded with the discovery of a strong association with better outcomes in patients receiving cardiac resynchronization therapy.

Methods

Several milestones have contributed to the current understanding on the role of LBBB in clinical practice.

Result

Sunao Tawara described the arrangement of components of what he called the cardiac conduction system from the atrioventricular node to the terminal Purkinje fibers that connect to the working myocardium, and his hypotheses on how it functions remain current. Mauricio Rosenbaum and colleagues developed the bifascicular model of the left-sided conduction system that explains the characteristic electrocardiographic changes associated with propagation disturbances in its components. Andrés Ricardo Pérez-Riera and others have disputed the bifascicular model as oversimplified and have emphasized the role of the left septal fascicle. Marcelo Elizari and colleagues have explained the importance of masquerading bundle branch block. Elena Sgarbossa and colleagues developed a scheme to recognize ST elevation myocardial infarction in patients with left bundle branch block which remains current after more than 20 years. Enrique Cabrera and others identified electrocardiographic signs of remote myocardial infarction.

Conclusion

Substantial progress has been made in the understanding of LBBB, yet its role in clinical practice continues to evolve and important gaps remain to which research should be directed.

     

Sex-Specific Mortality Risk by QRS Morphology and Duration in Patients Receiving CRT : Results From the NCDR

Background

Prior studies have suggested that women have better outcomes than men after cardiac resynchronization therapy-defibrillator (CRT-D) implantation.

Objectives

The purpose of this study was to compare mortality after CRT-D implantation by sex, QRS morphology, and duration.

Methods

Survival curves and covariate adjusted hazard ratios (HR) were used to assess mortality by sex in 31,892 CRT-D patients in the National Cardiovascular Data Registry (NCDR), implantable cardioverter defibrillator (ICD) registry between 2006 and 2009, with up to 5 years’ follow-up (median 2.9 years, interquartile range: 2.0 to 3.9 years). Patients were grouped by QRS morphology and 10-ms increments in QRS duration.

Results

Among patients with left bundle branch block (LBBB), women had a 21% lower mortality risk than men (HR: 0.79; 95% CI: 0.74 to 0.84; p < 0.001); however, there was no sex difference in non-LBBB (HR: 0.95; 95% CI: 0.85 to 1.06; p = 0.37). Longer QRS duration was associated with better survival in both sexes with LBBB, but not in patients without LBBB. Compared with women with LBBB and QRS of 120 to 129 ms, women with LBBB and QRS of 140 to 149 ms had a 27% lower mortality (HR: 0.73; 95% CI: 0.60 to 0.88; p = 0.001); this difference was 18% in men (HR: 0.82; 95% CI: 0.71 to 0.93; p = 0.003). Mortality in LBBB and QRS of 150 ms or longer compared with those with LBBB and QRS of 120 to 129 ms was similar between sexes (HR: 0.61 to 0.68; p < 0.001 for women and HR: 0.58 to 0.66; p < 0.001 for men). Sex interactions within 10-ms groups were not significant.

Conclusions

Among patients with LBBB who received CRT-D, mortality is lower in women than men. Additionally, longer QRS duration in LBBB is associated with better survival in both sexes. In contrast, there is no sex difference in patients without LBBB, regardless of QRS duration. Further studies should include a non-CRT comparator group to confirm these findings.     

Post-recurrence survival in hepatocellular carcinoma after percutaneous radiofrequency ablation

Background

Overall survival in hepatocellular carcinoma patients treated with percutaneous radiofrequency ablation is influenced by both recurrence and successive treatments. We investigated post-recurrence survival after radiofrequency ablation.

Methods

Data on 103 early/intermediate patients initially treated with radiofrequency ablation and followed for a median of 78 months (range 68–82) were retrospectively analysed. If intrahepatic disease recurrence occurred within or contiguous to the previously treated area it was defined as local, otherwise as distant; recurrence classified as Barcelona Clinic Liver Cancer stage C was defined by neoplastic portal vein thrombosis or metastases.

Results

A total of 103 patients were included (82.5% male; median age 70 years, range 39–86). During follow-up, 64 recurrences were observed. Median overall survival was 62 months (95% confidence interval: 54–78) and survival rates were 97%, 65% and 52% at 1, 4 and 5 years, respectively. Median post-recurrence survival was 22 months (95% confidence interval: 16–35). Child–Pugh score, performance status, sum of tumour diameters at recurrence and recurrence patterns were independent predictors of post-recurrence survival.

Conclusions

In patients with hepatocellular carcinoma after radiofrequency ablation, clinical and tumour parameters assessed at relapse, in particular the type of recurrence pattern, influence post-recurrence survival.