Long-Term Outcomes of Catheter Ablation of Ventricular Tachycardia in Patients with Cardiac Sarcoidosis

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

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background-Catheter ablation (CA) of ventricular tachycardia (VT) in patients with cardiac sarcoidosis can be challenging because of the complex underlying substrate. We sought to determine the long-term outcome of CA of VT in patients with cardiac sarcoidosis. Methods and Results-We enrolled 31 patients (age, 55±10 years) with diagnosis of cardiac sarcoidosis based on Heart Rhythm Society criteria and VT who underwent CA. In 23 (74%) patients, preprocedure cardiac magnetic resonance imaging and positron emission tomographic (PET) evaluation were performed. Preprocedure magnetic resonance imaging was positive for late gadolinium enhancement in 21 of 23 (91%) patients, whereas abnormal 18-fluorodeoxyglucose uptake was found in 15 of 23 (65%) cases. In 14 of 15 patients with positive PET at baseline, PET was repeated after 6.1±3.7-month follow-up. After a median follow-up of 2.5 (range, 0-10.5) years, 1 (3%) patient died and 4 (13%) underwent heart transplant. Overall VT-free survival was 55% at 2-year follow-up. Among the 16 (52%) patients with VT recurrences, CA resulted in a significant reduction of VT burden, with 8 (50%) having only isolated (1-3) VT episodes and only 1 patient with recurrent VT storm. The presence of late gadolinium enhancement at magnetic resonance imaging, a positive PET at baseline, and lack of PET improvement over follow-up were associated with increased risk of recurrent VT. Conclusions-In patients with cardiac sarcoidosis and VT, CA is effective in achieving long-term freedom from VT or improvement in VT burden in the majority of patients. The presence of late gadolinium enhancement at magnetic resonance imaging, a positive PET scan at baseline, or lack of improvement at repeat PET over follow-up predict worse arrhythmia-free survival.

LanguageEnglish
Article numbere004333
JournalCirculation: Arrhythmia and Electrophysiology
Volume9
Issue number8
DOIs
Publication statusPublished - 1 Aug 2016

Keywords

  • catheter ablation
  • fluorodeoxyglucose F18
  • positron-emission tomography
  • sarcoidosis, cardiac
  • tachycardia, ventricular

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Muser, D., Santangeli, P., Pathak, R. K., Castro, S. A., Liang, J. J., Magnani, S., ... Marchlinski, F. E. (2016). Long-Term Outcomes of Catheter Ablation of Ventricular Tachycardia in Patients with Cardiac Sarcoidosis. Circulation: Arrhythmia and Electrophysiology, 9(8), [e004333]. https://doi.org/10.1161/CIRCEP.116.004333
Muser, Daniele ; Santangeli, Pasquale ; Pathak, Rajeev K. ; Castro, Simon A. ; Liang, Jackson J. ; Magnani, Silvia ; Hayashi, Tatsuya ; Garcia, Fermin C. ; Hutchinson, Mathew D. ; Supple, Gregory E. ; Frankel, David S. ; Riley, Michael P. ; Lin, David ; Schaller, Robert D. ; Desjardins, Benoit ; Dixit, Sanjay ; Callans, David J. ; Zado, Erica S. ; Marchlinski, Francis E. / Long-Term Outcomes of Catheter Ablation of Ventricular Tachycardia in Patients with Cardiac Sarcoidosis. In: Circulation: Arrhythmia and Electrophysiology. 2016 ; Vol. 9, No. 8.
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title = "Long-Term Outcomes of Catheter Ablation of Ventricular Tachycardia in Patients with Cardiac Sarcoidosis",
abstract = "Background-Catheter ablation (CA) of ventricular tachycardia (VT) in patients with cardiac sarcoidosis can be challenging because of the complex underlying substrate. We sought to determine the long-term outcome of CA of VT in patients with cardiac sarcoidosis. Methods and Results-We enrolled 31 patients (age, 55±10 years) with diagnosis of cardiac sarcoidosis based on Heart Rhythm Society criteria and VT who underwent CA. In 23 (74{\%}) patients, preprocedure cardiac magnetic resonance imaging and positron emission tomographic (PET) evaluation were performed. Preprocedure magnetic resonance imaging was positive for late gadolinium enhancement in 21 of 23 (91{\%}) patients, whereas abnormal 18-fluorodeoxyglucose uptake was found in 15 of 23 (65{\%}) cases. In 14 of 15 patients with positive PET at baseline, PET was repeated after 6.1±3.7-month follow-up. After a median follow-up of 2.5 (range, 0-10.5) years, 1 (3{\%}) patient died and 4 (13{\%}) underwent heart transplant. Overall VT-free survival was 55{\%} at 2-year follow-up. Among the 16 (52{\%}) patients with VT recurrences, CA resulted in a significant reduction of VT burden, with 8 (50{\%}) having only isolated (1-3) VT episodes and only 1 patient with recurrent VT storm. The presence of late gadolinium enhancement at magnetic resonance imaging, a positive PET at baseline, and lack of PET improvement over follow-up were associated with increased risk of recurrent VT. Conclusions-In patients with cardiac sarcoidosis and VT, CA is effective in achieving long-term freedom from VT or improvement in VT burden in the majority of patients. The presence of late gadolinium enhancement at magnetic resonance imaging, a positive PET scan at baseline, or lack of improvement at repeat PET over follow-up predict worse arrhythmia-free survival.",
keywords = "catheter ablation, fluorodeoxyglucose F18, positron-emission tomography, sarcoidosis, cardiac, tachycardia, ventricular",
author = "Daniele Muser and Pasquale Santangeli and Pathak, {Rajeev K.} and Castro, {Simon A.} and Liang, {Jackson J.} and Silvia Magnani and Tatsuya Hayashi and Garcia, {Fermin C.} and Hutchinson, {Mathew D.} and Supple, {Gregory E.} and Frankel, {David S.} and Riley, {Michael P.} and David Lin and Schaller, {Robert D.} and Benoit Desjardins and Sanjay Dixit and Callans, {David J.} and Zado, {Erica S.} and Marchlinski, {Francis E.}",
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Muser, D, Santangeli, P, Pathak, RK, Castro, SA, Liang, JJ, Magnani, S, Hayashi, T, Garcia, FC, Hutchinson, MD, Supple, GE, Frankel, DS, Riley, MP, Lin, D, Schaller, RD, Desjardins, B, Dixit, S, Callans, DJ, Zado, ES & Marchlinski, FE 2016, 'Long-Term Outcomes of Catheter Ablation of Ventricular Tachycardia in Patients with Cardiac Sarcoidosis', Circulation: Arrhythmia and Electrophysiology, vol. 9, no. 8, e004333. https://doi.org/10.1161/CIRCEP.116.004333

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

In: Circulation: Arrhythmia and Electrophysiology, Vol. 9, No. 8, e004333, 01.08.2016.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Long-Term Outcomes of Catheter Ablation of Ventricular Tachycardia in Patients with Cardiac Sarcoidosis

AU - Muser, Daniele

AU - Santangeli, Pasquale

AU - Pathak, Rajeev K.

AU - Castro, Simon A.

AU - Liang, Jackson J.

AU - Magnani, Silvia

AU - Hayashi, Tatsuya

AU - Garcia, Fermin C.

AU - Hutchinson, Mathew D.

AU - Supple, Gregory E.

AU - Frankel, David S.

AU - Riley, Michael P.

AU - Lin, David

AU - Schaller, Robert D.

AU - Desjardins, Benoit

AU - Dixit, Sanjay

AU - Callans, David J.

AU - Zado, Erica S.

AU - Marchlinski, Francis E.

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Background-Catheter ablation (CA) of ventricular tachycardia (VT) in patients with cardiac sarcoidosis can be challenging because of the complex underlying substrate. We sought to determine the long-term outcome of CA of VT in patients with cardiac sarcoidosis. Methods and Results-We enrolled 31 patients (age, 55±10 years) with diagnosis of cardiac sarcoidosis based on Heart Rhythm Society criteria and VT who underwent CA. In 23 (74%) patients, preprocedure cardiac magnetic resonance imaging and positron emission tomographic (PET) evaluation were performed. Preprocedure magnetic resonance imaging was positive for late gadolinium enhancement in 21 of 23 (91%) patients, whereas abnormal 18-fluorodeoxyglucose uptake was found in 15 of 23 (65%) cases. In 14 of 15 patients with positive PET at baseline, PET was repeated after 6.1±3.7-month follow-up. After a median follow-up of 2.5 (range, 0-10.5) years, 1 (3%) patient died and 4 (13%) underwent heart transplant. Overall VT-free survival was 55% at 2-year follow-up. Among the 16 (52%) patients with VT recurrences, CA resulted in a significant reduction of VT burden, with 8 (50%) having only isolated (1-3) VT episodes and only 1 patient with recurrent VT storm. The presence of late gadolinium enhancement at magnetic resonance imaging, a positive PET at baseline, and lack of PET improvement over follow-up were associated with increased risk of recurrent VT. Conclusions-In patients with cardiac sarcoidosis and VT, CA is effective in achieving long-term freedom from VT or improvement in VT burden in the majority of patients. The presence of late gadolinium enhancement at magnetic resonance imaging, a positive PET scan at baseline, or lack of improvement at repeat PET over follow-up predict worse arrhythmia-free survival.

AB - Background-Catheter ablation (CA) of ventricular tachycardia (VT) in patients with cardiac sarcoidosis can be challenging because of the complex underlying substrate. We sought to determine the long-term outcome of CA of VT in patients with cardiac sarcoidosis. Methods and Results-We enrolled 31 patients (age, 55±10 years) with diagnosis of cardiac sarcoidosis based on Heart Rhythm Society criteria and VT who underwent CA. In 23 (74%) patients, preprocedure cardiac magnetic resonance imaging and positron emission tomographic (PET) evaluation were performed. Preprocedure magnetic resonance imaging was positive for late gadolinium enhancement in 21 of 23 (91%) patients, whereas abnormal 18-fluorodeoxyglucose uptake was found in 15 of 23 (65%) cases. In 14 of 15 patients with positive PET at baseline, PET was repeated after 6.1±3.7-month follow-up. After a median follow-up of 2.5 (range, 0-10.5) years, 1 (3%) patient died and 4 (13%) underwent heart transplant. Overall VT-free survival was 55% at 2-year follow-up. Among the 16 (52%) patients with VT recurrences, CA resulted in a significant reduction of VT burden, with 8 (50%) having only isolated (1-3) VT episodes and only 1 patient with recurrent VT storm. The presence of late gadolinium enhancement at magnetic resonance imaging, a positive PET at baseline, and lack of PET improvement over follow-up were associated with increased risk of recurrent VT. Conclusions-In patients with cardiac sarcoidosis and VT, CA is effective in achieving long-term freedom from VT or improvement in VT burden in the majority of patients. The presence of late gadolinium enhancement at magnetic resonance imaging, a positive PET scan at baseline, or lack of improvement at repeat PET over follow-up predict worse arrhythmia-free survival.

KW - catheter ablation

KW - fluorodeoxyglucose F18

KW - positron-emission tomography

KW - sarcoidosis, cardiac

KW - tachycardia, ventricular

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U2 - 10.1161/CIRCEP.116.004333

DO - 10.1161/CIRCEP.116.004333

M3 - Article

VL - 9

JO - Circulation: Arrhythmia and Electrophysiology

T2 - Circulation: Arrhythmia and Electrophysiology

JF - Circulation: Arrhythmia and Electrophysiology

SN - 1941-3149

IS - 8

M1 - e004333

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