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

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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.

Original 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