TY - JOUR
T1 - Outcomes of Catheter Ablation of Ventricular Tachycardia Based on Etiology in Nonischemic Heart Disease
T2 - An International Ventricular Tachycardia Ablation Center Collaborative Study
AU - Vaseghi, Marmar
AU - Hu, Tiffany Y.
AU - Tung, Roderick
AU - Vergara, Pasquale
AU - Frankel, David S.
AU - Di Biase, Luigi
AU - Tedrow, Usha B.
AU - Gornbein, Jeffrey A.
AU - Yu, Ricky
AU - Mathuria, Nilesh
AU - Nakahara, Shiro
AU - Tzou, Wendy S.
AU - Sauer, William H.
AU - Burkhardt, J. David
AU - Tholakanahalli, Venkatakrishna N.
AU - Dickfeld, Timm Michael
AU - Weiss, J. Peter
AU - Bunch, T. Jared
AU - Reddy, Madhu
AU - Callans, David J.
AU - Lakkireddy, Dhanunjaya R.
AU - Natale, Andrea
AU - Marchlinski, Francis E.
AU - Stevenson, William G.
AU - Della Bella, Paolo
AU - Shivkumar, Kalyanam
N1 - Publisher Copyright:
© 2018 American College of Cardiology Foundation
PY - 2018/9
Y1 - 2018/9
N2 - Objectives: This study sought to characterize ventricular tachycardia (VT) ablation outcomes across nonischemic cardiomyopathy (NICM) etiologies and adjust these outcomes by patient-related comorbidities that could explain differences in arrhythmia recurrence rates. Background: Outcomes of catheter ablation of VT in patients with NICM could be related to etiology of NICM. Methods: Data from 2,075 patients with structural heart disease referred for catheter ablation of VT from 12 international centers was retrospectively analyzed. Patient characteristics and outcomes were noted for the 6 most common NICM etiologies. Multivariable Cox proportional hazards modeling was used to adjust for potential confounders. Results: Of 780 NICM patients (57 ± 14 years of age, 18% women, left ventricular ejection fraction 37 ± 13%), underlying prevalence was 66% for dilated idiopathic cardiomyopathy (DICM), 13% for arrhythmogenic right ventricular cardiomyopathy (ARVC), 6% for valvular cardiomyopathy, 6% for myocarditis, 4% for hypertrophic cardiomyopathy, and 3% for sarcoidosis. One-year freedom from VT was 69%, and freedom from VT, heart transplantation, and death was 62%. On unadjusted competing risk analysis, VT ablation in ARVC demonstrated superior VT-free survival (82%) versus DICM (p ≤ 0.01). Valvular cardiomyopathy had the poorest unadjusted VT-free survival, at 47% (p < 0.01). After adjusting for comorbidities, including age, heart failure severity, ejection fraction, prior ablation, and antiarrhythmic medication use, myocarditis, ARVC, and DICM demonstrated similar outcomes, whereas hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis had the highest risk of VT recurrence. Conclusions: Catheter ablation of VT in NICM is effective. Etiology of NICM is a significant predictor of outcomes, with ARVC, myocarditis, and DICM having similar but superior outcomes to hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis, after adjusting for potential covariates.
AB - Objectives: This study sought to characterize ventricular tachycardia (VT) ablation outcomes across nonischemic cardiomyopathy (NICM) etiologies and adjust these outcomes by patient-related comorbidities that could explain differences in arrhythmia recurrence rates. Background: Outcomes of catheter ablation of VT in patients with NICM could be related to etiology of NICM. Methods: Data from 2,075 patients with structural heart disease referred for catheter ablation of VT from 12 international centers was retrospectively analyzed. Patient characteristics and outcomes were noted for the 6 most common NICM etiologies. Multivariable Cox proportional hazards modeling was used to adjust for potential confounders. Results: Of 780 NICM patients (57 ± 14 years of age, 18% women, left ventricular ejection fraction 37 ± 13%), underlying prevalence was 66% for dilated idiopathic cardiomyopathy (DICM), 13% for arrhythmogenic right ventricular cardiomyopathy (ARVC), 6% for valvular cardiomyopathy, 6% for myocarditis, 4% for hypertrophic cardiomyopathy, and 3% for sarcoidosis. One-year freedom from VT was 69%, and freedom from VT, heart transplantation, and death was 62%. On unadjusted competing risk analysis, VT ablation in ARVC demonstrated superior VT-free survival (82%) versus DICM (p ≤ 0.01). Valvular cardiomyopathy had the poorest unadjusted VT-free survival, at 47% (p < 0.01). After adjusting for comorbidities, including age, heart failure severity, ejection fraction, prior ablation, and antiarrhythmic medication use, myocarditis, ARVC, and DICM demonstrated similar outcomes, whereas hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis had the highest risk of VT recurrence. Conclusions: Catheter ablation of VT in NICM is effective. Etiology of NICM is a significant predictor of outcomes, with ARVC, myocarditis, and DICM having similar but superior outcomes to hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis, after adjusting for potential covariates.
KW - ablation
KW - arrhythmogenic right ventricular cardiomyopathy
KW - myocarditis
KW - nonischemic
KW - sarcoidosis
KW - valvular
KW - ventricular tachycardia
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U2 - 10.1016/j.jacep.2018.05.007
DO - 10.1016/j.jacep.2018.05.007
M3 - Article
C2 - 30236386
AN - SCOPUS:85052960048
SN - 2405-500X
VL - 4
SP - 1141
EP - 1150
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 9
ER -