Endocardial and adjuvant epicardial catheter ablation achieved long-term ventricular tachycardia freedom in 69% of patients with nonischemic dilated cardiomyopathy at 60 months.
Cohort (n=282)
Does endocardial and adjuvant epicardial catheter ablation improve long-term VT-free survival in patients with nonischemic dilated cardiomyopathy?
Catheter ablation for ventricular tachycardia in nonischemic dilated cardiomyopathy provides long-term VT freedom in 69% of patients at 5 years and significantly reduces VT burden in those with recurrences.
BACKGROUND: Catheter ablation (CA) of ventricular tachycardia (VT) in patients with nonischemic dilated cardiomyopathy can be challenging because of the complexity of underlying substrates. We sought to determine the long-term outcomes of endocardial and adjuvant epicardial CA in nonischemic dilated cardiomyopathy. METHODS AND RESULTS: We examined 282 consecutive patients (aged 59±15 years, 80% males) with nonischemic dilated cardiomyopathy who underwent CA. Ablation was guided by activation/entrainment mapping for tolerated VT and pacemapping/targeting of abnormal electrograms for unmappable VT. Adjuvant epicardial ablation was performed for recurrent VT or persistent inducibility after endocardial-only ablation. Epicardial ablation was performed in 90 (32%) patients. Before ablation, patients failed a median of 2 antiarrhythmic drugs), including amiodarone, in 166 (59%) patients. The median follow-up after the last procedure was 48 (19-67) months. Overall, VT-free survival was 69% at 60-month follow-up. Transplant-free survival was 76% and 68% at 60- and 120-month follow-up, respectively. Among the 58 (21%) patients with VT recurrence, CA still resulted in a significant reduction of VT burden, with 31 (53%) patients having only isolated (1-3) VT episodes in 12 (4-35) months after the procedure. At the last follow-up, 128 (45%) patients were only on β-blockers or no treatment, 41 (15%) were on sotalol or class I antiarrhythmic drugs, and 62 (22%) were on amiodarone. CONCLUSIONS: In patients with nonischemic dilated cardiomyopathy and VT, endocardial and adjuvant epicardial CA is effective in achieving long-term VT freedom in 69% of cases, with a substantial improvement in VT burden in many of the remaining patients.
Muser et al. (Sat,) conducted a cohort in Ventricular tachycardia in nonischemic dilated cardiomyopathy (n=282). Endocardial and adjuvant epicardial catheter ablation was evaluated on Ventricular tachycardia-free survival at 60-month follow-up. Endocardial and adjuvant epicardial catheter ablation achieved long-term ventricular tachycardia freedom in 69% of patients with nonischemic dilated cardiomyopathy at 60 months.