Catheter Ablation of Ventricular Tachycardia in Nonischemic Heart Disease

Abstract

Background-Catheter ablation of ventricular tachycardia (VT) in nonischemic heart diseases can be challenging, and outcomes across different diseases are incompletely defined. The aim of this study was to describe the outcomes after catheter ablation for nonischemic VT in a large cohort and to compare the electrophysiological findings and outcomes according to the type of underlying disease. Methods and Results-Of the 891 consecutive patients undergoing catheter ablation for ventricular arrhythmias, 226 patients (52±14 years; 79% men) with sustained VT due to nonischemic heart disease were included. The primary end point was all-cause death or heart transplantation. Secondary end points were a composite of death, heart transplantation, or readmission because of VT recurrence within 1 year of discharge. Underlying heart diseases were dilated cardiomyopathy in 119 (53%), valvular heart disease in 34 (15%), arrhythmogenic right ventricular cardiomyopathy in 37 (16%), congenital heart disease in 16 (7%), cardiac sarcoidosis in 13 (6%), and hypertrophic cardiomyopathy in 7 (3%) patients. After ablation, inability to induce any VT was achieved in 55%, and another 20% had inducible VTs modified. Major complications occurred in 5%. Arrhythmogenic right ventricular cardiomyopathy had better outcomes than dilated cardiomyopathy for primary (P=0.002) and secondary end points (P=0.004). Sarcoidosis had worse outcome than dilated cardiomyopathy for secondary end point (P=0.002). At 1 year after the last ablation (a mean of 1.4±0.6 procedures, 1-4), freedom from death, heart transplantation, and readmission for VT recurrence were achieved in 173 (77%) patients. Conclusions-In patients with recurrent VT due to nonischemic heart disease, catheter ablation is often useful, although the outcome varies according to the nature of the underlying heart disease. (Circ Arrhythm Electrophysiol. 2012;5:992-1000.)

Ventricular arrhythmias in nonischemic cardiomyopathy

“…In one retrospective study on 226 NICM patients undergoing ablation for drug‐refractory VT, the survival was achieved, with no further requirement for heart transplants and readmissions for VT recurrences, in 173 (77%) patients. In that study, the patients with ARVC had better outcomes than those with DCM, whereas the patients with sarcoidosis had the worst outcomes 48, 77. Another recent retrospective study on 282 NICM VT patients yielded consistent results in achieving a long‐term freedom from VT in 69% of cases 78.…”

Outcomes in Catheter Ablation of Ventricular Tachycardia in Dilated Nonischemic Cardiomyopathy Compared With Ischemic Cardiomyopathy

“…In a recent study in patients with NIDCM VT, noninducibility failed to predict long-term success even after epicardial ablation. 12 The Heart Center of Leipzig VT (HELP-VT) study was conducted prospectively to compare the outcomes after radiofrequency catheter ablation of VT in NIDCM and ICM. Furthermore, we sought to determine the predictors for the short-and long-term success rates in NIDCM.…”

“…[1][2][3][4][5][6][7] Studies addressing the outcomes in nonischemic dilated cardiomyopathy (NIDCM) patients are fewer, include smaller groups of patients, and have reported worse outcomes. [8][9][10][11][12] A more recent multicenter trial in epicardial VT ablation suggested comparable outcomes in ischemic cardiomyopathy (ICM) and NIDCM, with a reported VT recurrence in 39.3% in NIDCM versus 34.7% in ICM. 13 …”

Long‐term outcomes of catheter ablation of ventricular tachycardia in patients with structural heart disease

“…This difference in the underlying diseases might lead to different ablation outcomes. Tokuda et al [39] recently reported the long-term follow-up outcomes of VT ablation in patients with non-IHD. In that study, the ARVC-VT ablation outcomes were significantly better than the NIDCM-VT ablation outcomes, which is consistent with our study results.…”