{
  "abstract": "Introduction Ventricular tachycardia (VT) in patients with implantable cardioverter defibrillators (ICDs) is typically managed with a combination of anti-arrhythmic drugs (AADs), catheter ablation, and optimisation of anti-tachycardia therapies. However, specifically targeting comorbidity burden in these patients remains under-explored. We describe a tailored multidisciplinary VT clinic model that focuses on the specific optimisation of comorbidities, with the potential for a scalable service improvement delivered by trained Cardiac Physiologists within existing device clinics.Methods A dedicated VT device clinic was established at a single tertiary centre in 2020. Consecutive patients underwent serial in-person and remote reviews led by band 7 Physiologists with Physician supervision. The nature and extent of medical comorbidities was identified via structured proforma (including EQ-5D-5L questionnaires), and optimisation strategies included initiation or escalation of heart failure medications, treatment of thyroid dysfunction, management of iron deficiency, investigation and treatment of suspected ischaemia, and identification of sleep-apnoea requiring continuous positive airway pressure (CPAP). Baseline patient characteristics, VT burden and quality of life metrics before and after clinic input were recorded.Results 473 patients were referred for clinical review following appropriate ICD therapies for VT/VF and were followed-up for a mean of 20.9 ± 25.9 months. 87 individuals (84% male, 52% ischaemic cardiomyopathy, mean LVEF 32%) underwent comorbidity optimisation as their sole management strategy. In this subgroup, optimisation of heart failure pharmacotherapy was undertaken in 31 patients (36%). Iron deficiency was identified and treated in 8 patients (9%), and obstructive sleep apnoea requiring CPAP therapy was confirmed on sleep study in a further 8 patients (9%). Thyroid dysfunction necessitating treatment was detected in 3 patients (3%). Ischaemia testing was positive in 6 patients (7%). No patients in this subgroup required CRT upgrade as part of their optimisation pathway.For the whole cohort, when adjusting for ejection fraction, NYHA class, biological sex, and the other three interventional strategies, comorbidity optimisation was independently associated with reduced VT recurrence at 12 months (adjusted HR: 0.61 (0.35-0.84), p=0.004) and a reduction in overall VT burden (adjusted effect size 0.82 (0.33-0.9), p=0.02). Across five health-related quality of life domains, median utility scores deteriorated with AADs (decrement: -0.05) but improved with comorbidity optimisation (increment: 0.075), device reprogramming (increment: 0.1), and VT ablation (increment: 0.11).Conclusions Comorbidity optimisation identified several modifiable factors relevant to VT burden and quality of life, including thyroid dysfunction, iron deficiency, sleep apnoea, and suboptimal heart failure therapy. A structured approach provides a low-risk pathway that may contribute to non-invasive VT management, and provides a potential educational and role-development framework for Cardiac Physiologists.Abstract 141 Figure 1",
  "authors": [
    {
      "affiliations": [
        "Barts and the London School of Medicine and Dentistry, London, United Kingdom"
      ],
      "name": "Rabia Hussain"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Edd Maclean"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Luke Sevier"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Johanna Tonko"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Yang Chen"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Adam Dennis"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Ruben Lamelas"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Hollie Page"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Samuel Martin"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Sarah Whittaker-Axon"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Christopher Monkhouse"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Pier Lambiase"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Richard Schilling"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Mehul Dhinoja"
    },
    {
      "affiliations": [
        "Barts and the London School of Medicine and Dentistry, London, United Kingdom"
      ],
      "name": "Kushal Krishna Banerjee"
    }
  ],
  "title": "141 Impact of physiologist-led comorbidity optimisation in a tertiary vt clinic",
  "uid": "fd4bb147-3a65-5dda-acfc-d3773034b377"
}