Long-Term Outcome after Catheter Ablation of Ventricular Tachycardia in Patients with Nonischemic Dilated Cardiomyopathy

Daniele Muser, Pasquale Santangeli, Simon A. Castro, Rajeev Pathak, Jackson J. Liang, Tatsuya Hayashi, Silvia Magnani, Fermin C. Garcia, Mathew D. Hutchinson, Gregory G. Supple, David S. Frankel, Michael P. Riley, David Lin, Robert D. Schaller, Sanjay Dixit, Erica S. Zado, David J. Callans, Francis E. Marchlinski

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

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.

LanguageEnglish
Article numbere004328
JournalCirculation: Arrhythmia and Electrophysiology
Volume9
Issue number10
DOIs
Publication statusPublished - 1 Oct 2016

Keywords

  • antiarrhythmic drug
  • catheter ablation
  • dilated cardiomyopathy
  • electroanatomic mapping
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Muser, Daniele ; Santangeli, Pasquale ; Castro, Simon A. ; Pathak, Rajeev ; Liang, Jackson J. ; Hayashi, Tatsuya ; Magnani, Silvia ; Garcia, Fermin C. ; Hutchinson, Mathew D. ; Supple, Gregory G. ; Frankel, David S. ; Riley, Michael P. ; Lin, David ; Schaller, Robert D. ; Dixit, Sanjay ; Zado, Erica S. ; Callans, David J. ; Marchlinski, Francis E. / Long-Term Outcome after Catheter Ablation of Ventricular Tachycardia in Patients with Nonischemic Dilated Cardiomyopathy. In: Circulation: Arrhythmia and Electrophysiology. 2016 ; Vol. 9, No. 10.
@article{edc268a6bfca4f61a367b997b7494b7a,
title = "Long-Term Outcome after Catheter Ablation of Ventricular Tachycardia in Patients with Nonischemic Dilated Cardiomyopathy",
abstract = "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.",
keywords = "antiarrhythmic drug, catheter ablation, dilated cardiomyopathy, electroanatomic mapping, ventricular tachycardia",
author = "Daniele Muser and Pasquale Santangeli and Castro, {Simon A.} and Rajeev Pathak and Liang, {Jackson J.} and Tatsuya Hayashi and Silvia Magnani and Garcia, {Fermin C.} and Hutchinson, {Mathew D.} and Supple, {Gregory G.} and Frankel, {David S.} and Riley, {Michael P.} and David Lin and Schaller, {Robert D.} and Sanjay Dixit and Zado, {Erica S.} and Callans, {David J.} and Marchlinski, {Francis E.}",
year = "2016",
month = "10",
day = "1",
doi = "10.1161/CIRCEP.116.004328",
language = "English",
volume = "9",
journal = "Circulation: Arrhythmia and Electrophysiology",
issn = "1941-3149",
publisher = "Lippincott Williams and Wilkins",
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Muser, D, Santangeli, P, Castro, SA, Pathak, R, Liang, JJ, Hayashi, T, Magnani, S, Garcia, FC, Hutchinson, MD, Supple, GG, Frankel, DS, Riley, MP, Lin, D, Schaller, RD, Dixit, S, Zado, ES, Callans, DJ & Marchlinski, FE 2016, 'Long-Term Outcome after Catheter Ablation of Ventricular Tachycardia in Patients with Nonischemic Dilated Cardiomyopathy', Circulation: Arrhythmia and Electrophysiology, vol. 9, no. 10, e004328. https://doi.org/10.1161/CIRCEP.116.004328

Long-Term Outcome after Catheter Ablation of Ventricular Tachycardia in Patients with Nonischemic Dilated Cardiomyopathy. / Muser, Daniele; Santangeli, Pasquale; Castro, Simon A.; Pathak, Rajeev; Liang, Jackson J.; Hayashi, Tatsuya; Magnani, Silvia; Garcia, Fermin C.; Hutchinson, Mathew D.; Supple, Gregory G.; Frankel, David S.; Riley, Michael P.; Lin, David; Schaller, Robert D.; Dixit, Sanjay; Zado, Erica S.; Callans, David J.; Marchlinski, Francis E.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 9, No. 10, e004328, 01.10.2016.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Long-Term Outcome after Catheter Ablation of Ventricular Tachycardia in Patients with Nonischemic Dilated Cardiomyopathy

AU - Muser, Daniele

AU - Santangeli, Pasquale

AU - Castro, Simon A.

AU - Pathak, Rajeev

AU - Liang, Jackson J.

AU - Hayashi, Tatsuya

AU - Magnani, Silvia

AU - Garcia, Fermin C.

AU - Hutchinson, Mathew D.

AU - Supple, Gregory G.

AU - Frankel, David S.

AU - Riley, Michael P.

AU - Lin, David

AU - Schaller, Robert D.

AU - Dixit, Sanjay

AU - Zado, Erica S.

AU - Callans, David J.

AU - Marchlinski, Francis E.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - 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.

AB - 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.

KW - antiarrhythmic drug

KW - catheter ablation

KW - dilated cardiomyopathy

KW - electroanatomic mapping

KW - ventricular tachycardia

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U2 - 10.1161/CIRCEP.116.004328

DO - 10.1161/CIRCEP.116.004328

M3 - Article

VL - 9

JO - Circulation: Arrhythmia and Electrophysiology

T2 - Circulation: Arrhythmia and Electrophysiology

JF - Circulation: Arrhythmia and Electrophysiology

SN - 1941-3149

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