Primary Prevention of Sudden Cardiac Death in a Nonischemic Dilated Cardiomyopathy Population

Gatzoulis, Konstantinos; Vouliotis, Apostolos-Ilias; Tsiachris, Dimitris; Salourou, Maria; Archontakis, Stefanos; Dilaveris, Polychronis; Gialernios, Theodoros; Αρσένος, Πέτρος; Karystinos, Georgios; Sideris, Skevos; Kallikazaros, Ioannis; Stefanadis, Christodoulos

doi:10.1161/circep.113.000216

Cited by 65 publications

(42 citation statements)

References 26 publications

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“…20 In line with this finding, we proved a decreased likelihood of VT recurrence in patients with NIDCM and complete VT noninducibility in comparison with patients with partial success or failure after CA. Previously, Piers et al 19 reached the same conclusion and suggested that noninducibility may be an appropriate end point in patients with NIDCM.…”

Section: Vt Noninducibility After Ca and Vt Recurrencesupporting

confidence: 83%

Catheter Ablation of Ventricular Tachycardia and Mortality in Patients With Nonischemic Dilated Cardiomyopathy

Dinov

Arya

Schratter

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Background-Data on outcomes after catheter ablation of ventricular tachycardia (VT) in patients with nonischemic dilated cardiomyopathy (NIDCM) are insufficient. We aimed to investigate the effects of successful catheter ablation of VT on cardiac mortality in patients with NIDCM. Methods and Results-One hundred two patients with NIDCM (86 men; mean age, 58.8±15.2 years; mean ejection fraction, 33.3±11.9%) underwent VT ablation. After catheter ablation, a programmed ventricular stimulation to test for success was performed. Complete VT noninducibility was achieved in 62 (61%) patients and partial success or failure in 32 (31%) patients. During 2 years of follow-up, VT recurrence was observed in 33 patients (53%) without inducible VTs and in 24 patients (75%) with inducible VT inducible (P=0.041). VT inducibility was associated with higher VT recurrence (adjusted hazard ratio, 1.84; 95% confidence interval, 1.08-3.13; P=0.025). The primary end point of all-cause mortality was reached in 9 patients (15%) with noninducible VTs versus 11 patients (34%) with inducible sustained VTs (P=0.026). VT inducibility was associated with all-cause mortality (adjusted hazard ratio, 2.73; 95% confidence interval, 1.003-7.43; P=0.049). Conclusions-In patients with NIDCM and recurrent sustained VTs, a complete ablation of all inducible VTs may be achieved in 60% of the cases. The complete noninducibility may be a preferable end point of ablation because it was associated with better long-term success. Importantly, if possible to achieve through ablation, a complete VT noninducibility was associated with reduction of the likelihood for all-cause mortality in patients with NIDCM.

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Section: Vt Noninducibility After Ca and Vt Recurrencesupporting

confidence: 83%

Catheter Ablation of Ventricular Tachycardia and Mortality in Patients With Nonischemic Dilated Cardiomyopathy

Dinov

Arya

Schratter

et al. 2015

Circ: Arrhythmia and Electrophysiology

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“…However, several previous results have demonstrated discrepancies between inducible ventricular tachyarrhythmias using an EP study and the presence of VAs during the follow‐up in patients with NICM and heart failure 26, 27, 28. Moreover, a recent study29 monitored patients with idiopathic DCM prospectively and found a similar total mortality between the patients with positive and negative inducibility of ventricular tachycardia/ventricular fibrillation (VT/VF) during the follow‐up. However, overall ICD therapies were significantly higher in patients with a positive inducibility of ventricular tachyarrhythmias.…”

Section: Classification and Evaluation Of Nicmmentioning

confidence: 99%

Ventricular arrhythmias in nonischemic cardiomyopathy

Chung

Lin

et al. 2018

Journal of Arrhythmia

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Nonischemic cardiomyopathies (NICMs) are composed of variable disease entities, including primary and secondary cardiomyopathies. Determining the etiology of NICM provides pivotal roles of not only the understanding of the individual pathogenesis, but also the clinical management, such as risk stratification, pharmacological treatment, and intervention therapies. Despite the diverse causes of NICM, these cases mostly require clinical attention owing to progressive myocardial injury, resulting in ventricular dysfunction and heart failure. The interaction between the diseased ventricular substrates and systemic/neurophysiological factors contributes to the cornerstones responsible for ventricular arrhythmogenesis and sudden cardiac death (SCD). Prevention of SCD and diminishing ventricular tachyarrhythmias are the important mainstays for the management of NICM patients. Given the understanding of the abnormal ventricular substrates and advancement of navigation systems, radiofrequency catheter ablation (RFCA) has become an adjunctive or alternative strategy for NICM patients who experience drug‐refractory ventricular tachycardias (VTs). Successful ablation can frequently be achieved at the expense of an epicardial intervention. A recent study has proven the survival benefits for NICM patients who are free from recurrent VTs after a successful RFCA, regardless of the New York Heart Association (NYHA) functional class status or left ventricular ejection fraction. Additionally, recent evidence has highlighted the better delineation of a diseased myocardium through the incorporation of cardiovascular magnetic resonance imaging (CMRI) and 3D mapping systems, which can facilitate the identification of critical ventricular arrhythmogenic substrates in NICM patients.

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“…Extrastimuli were applied after a six-beat drive train with a 2-s interdrive pause. In DCM patients where no sustained ventricular tachyarrhythmia was triggered, PVS was repeated after intravenous isoproterenol administration (1-4 μg/kg/min) [2]. The presence of either sinus and/ or atrioventricular node disease was ascertained based on abnormal electrophysiological parameters [3].…”

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confidence: 99%

Prognostic value of programmed ventricular stimulation for sudden death in selected high risk patients with structural heart disease and preserved systolic function

Gatzoulis¹,

Tsiachris²,

Αρσένος³

et al. 2014

International Journal of Cardiology

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Primary Prevention of Sudden Cardiac Death in a Nonischemic Dilated Cardiomyopathy Population

Abstract: Inducibility of ventricular tachycardia/ventricular fibrillation was associated with an increased likelihood of subsequent ICD activation and sudden cardiac death surrogate.

Cited by 65 publications

References 26 publications

Catheter Ablation of Ventricular Tachycardia and Mortality in Patients With Nonischemic Dilated Cardiomyopathy

Catheter Ablation of Ventricular Tachycardia and Mortality in Patients With Nonischemic Dilated Cardiomyopathy

Ventricular arrhythmias in nonischemic cardiomyopathy

Prognostic value of programmed ventricular stimulation for sudden death in selected high risk patients with structural heart disease and preserved systolic function

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