Catheter Ablation Compared to Medical Therapy for Ventricular Tachycardia in Sarcoidosis: Outcomes and Hospital Readmissions in a Nationwide Cohort Study

Background Patients with cardiovascular manifestations of sarcoidosis are at an increased risk for ventricular arrhythmias (VA) and sudden cardiac death. Catheter ablation (CA) for ventricular tachycardia (VT) can be a useful treatment strategy, however, few studies have compared CA to medical therapy in this patient population. Objective To assess in-hospital outcomes and unplanned readmissions following CA for VT compared to medical therapy in patients with sarcoidosis. Methods Using ICD-9 and ICD-10 diagnostic and procedural codes, data was obtained from the Nationwide Readmissions Database between January 2010 and December 2019 to identify patients with a diagnosis of sarcoidosis admitted for VT either undergoing CA or medical therapy. Primary endpoints were 30-day unplanned hospital readmissions as well as a composite endpoint of inpatient mortality, cardiogenic shock, and cardiac arrest. Complications at index hospitalization and causes of readmission were also identified. Results Among a total of 1,581 patients, 1,349 patients with sarcoidosis and a diagnosis of VT were managed medically compared to 232 that underwent CA. Readmission rates at 30 days were 10.8% and 8.0%, respectively ( p =0.266). In univariate analysis, the composite endpoint of mortality, cardiac arrest and cardiogenic shock trended in favor of ablation (7.4% vs 11.7%, p =0.067). In the subgroup of patients undergoing elective CA for VT, there was an improvement in the univariate composite of mortality, cardiac arrest, and cardiogenic shock (3.2% vs. 11.7%, p =0.039). After multivariable adjustment, patients undergoing elective CA were less likely to be readmitted within 30-days (OR 0.23 [95% CI 0.05,0.90] p =0.042). The most common cause of readmission were VA in both groups, however, those undergoing elective CA were less likely to be readmitted for VA compared to non-elective ablation. Complications in the CA group included cardiac tamponade (4.7%), vascular complications (2.6%), and hematomas (3.0%). Conclusion In a national database of patients admitted with sarcoidosis and VT, when compared to medical therapy, CA results in a similar 30-day readmission rate with a trend towards reduction in the univariate composite endpoint of inpatient mortality, cardiogenic shock, and cardiac arrest. Patients undergoing elective VT ablation have a superior univariate outcome in the primary composite endpoint and were less likely to be readmitted within 30-days in adjusted analysis compared to medical therapy. Procedure related complications were low in the ablation group. The findings of short-term safety compared to medical therapy in addition to early intervention adds further support to an elective CA approach. Clinical Perspective What is New? We report nationwide in-hospital outcomes and readmission rates in sarcoidosis patients presenting with ventricular tachycardia (VT) undergoing catheter ablation (CA) as compared to medical therapy alone. Elective catheter ablation shows a superior reduction in a composite endpoint of inpatient mortality, cardiogenic shock, and cardiac arrest and are less likely to be readmitted within 30-days compared to medical therapy. Ventricular arrhythmias (VA) are the most common cause of readmission, however, patients undergoing elective CA are less likely to be readmitted for VA. What Are the Clinical Implications? VT ablation in sarcoidosis patients favors an elective ablation strategy over medical therapy alone, making pre-procedural optimization, patient selection, and timing critical for successful catheter ablation. Provides clinicians with guidance in formulating acute management decisions in sarcoid patients presenting with VT. Patients undergoing unplanned CA for VT as compared to elective CA have similar complication rates and no obvious increased risk of harm, suggesting that CA can be an important bailout for patients who cannot afford to wait until an elective ablation is performed.