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Efficacy of catheter ablation of ventricular tachycardia in patients with nonischemic dilated cardiomyopathy


Catheter ablation of ventricular tachycardia in patients with nonischemic dilated cardiomyopathy can be challenging because of the complexity of underlying substrates.
Researchers sought to determine the long-term outcomes of endocardial and adjuvant epicardial catheter ablation in nonischemic dilated cardiomyopathy.

282 consecutive patients ( aged 59±15 years, 80% males ) with nonischemic dilated cardiomyopathy who underwent catheter ablation were examined.

Ablation was guided by activation / entrainment mapping for tolerated ventricular tachycardia and pacemapping / targeting of abnormal electrograms for unmappable ventricular tachycardia.

Adjuvant epicardial ablation was performed for recurrent ventricular tachycardia 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 ( Cordarone ), in 166 ( 59% ) patients.

The median follow-up after the last procedure was 48 ( 19-67 ) months.

Overall, ventricular tachycardia-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 ventricular tachycardia recurrence, catheter ablation still resulted in a significant reduction of ventricular tachycardia burden, with 31 ( 53% ) patients having only isolated ( 1-3 ) ventricular tachycardia episodes in 12 ( 4-35 ) months after the procedure.

At the last follow-up, 128 ( 45% ) patients were only on beta-blockers or no treatment, 41 ( 15% ) were on Sotalol ( Sotalex ) or class I antiarrhythmic drugs, and 62 ( 22% ) were on Amiodarone.

In conclusion, in patients with nonischemic dilated cardiomyopathy and ventricular tachycardia, endocardial and adjuvant epicardial catheter ablation is effective in achieving long-term ventricular tachycardia freedom in 69% of cases, with a substantial improvement in ventricular tachycardia burden in many of the remaining patients. ( Xagena )

Muser D et al, Circ Arrhythm Electrophysiol 2016; 9(10). pii: e004328

XagenaMedicine_2016



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