Abstract 1120 Acute and long-term outcome after VT ablation of nonischemic cardiomyopathy: a single centre experience

Background:

It is well known that VT ablation success in patients with nonischemic cardiomyopathies is worse compared to ischemic cardiomyopathy. Therefore, this study investigates the acute and long-term outcome of multiple ablations in nonischemic cardiomyopathies.

Methods:

Between January 2016 and July 2022 consecutive patients with VT and nonischemic cardiomyopathies undergoing ablation were included. In total, 249 patients with 400 procedures were included. Procedure endpoints were non-inducibility of the clinical VT (partial success) as well VT non-inducibility (full success). Predictors of VT recurrences and repeat ablation approaches were investigated.

Results:

The underlying structural heart disease was dilated cardiomyopathy (DCM) in 48%, postmyocarditis in 21%, arrhythmogenic right ventricular disease (ARVC) in 8%, valvular heart disease in 8%, sarcoidosis in 7%, hypertrophic cardiomyopathy (H(o)CM) in 4%, non-compaction cardiomyopathy (NCCM) in 1% and congenital heart disease (CHD) in 1%. Epicardial access was performed in 52% of all cases. A mean of 1.61 ± 1.1 (range 1-8) ablations per patient were performed. Acute partial and full ablation success were 92% and 76%, respectively. Multivariate regression showed no influence of underlying heart disease on acute ablation success. Overall complication rates were acceptable with 14%. Intrahospital mortality was 2%, procedures-related mortality 0.25%. After a mean of 38 ± 21 months VT-free survival after one procedure was 45%, increasing to 64% after multiple procedures. Mean time between ablation and VT recurrence was 225 ± 326 days. Multivariate predictors of VT recurrence during follow-up were presence of electrical storm (HR 1.461, 95% CI 1.256 – 1.992; p=0.027) and myocarditis as underlying heart disease (HR 2.597, 95% CI 1.350 – 4.995; p=0.004). All-cause mortality during follow-up was 17%.

Conclusions:

Patients with NICM represent a vulnerable patient cohort, however VT ablation is feasible and safe among those patients with satisfying acute and long-term success rates. Especially VT ablations in NICM patients should be reserved to experiences centres with possibility for epicardial access.

Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
Acute and long-term outcome after VT ablation of nonischemic cardiomyopathy: a single centre experience
J. Müller¹, K. Nentwich², A. Berkovitz², P. Halbfaß³, E. Ene⁴, K. Sonne², I. Chakarov⁴, S. Barth⁵, T. Schupp⁶, M. Behnes⁶, T. Deneke²
¹Herz- und Gefäß-Klinik Campus Bad Neustadt, Bad Neustadt a. d. Saale; ²Klinik für Kardiologie II / Interventionelle Elektrophysiologie, RHÖN-KLINIKUM AG Campus Bad Neustadt, Bad Neustadt a. d. Saale; ³Klinik für Kardiologie, Klinikum Oldenburg AöR, Oldenburg; ⁴Kardiologie, RHÖN-KLINIKUM AG Campus Bad Neustadt, Bad Neustadt a. d. Saale; ⁵Klinik für Kardiologie I - Interventionelle Kardiologie und kardiale Bildgebung, RHÖN-KLINIKUM AG Campus Bad Neustadt, Bad Neustadt a. d. Saale; ⁶I. Medizinische Klinik, Universitätsklinikum Mannheim, Mannheim;
Background: It is well known that VT ablation success in patients with nonischemic cardiomyopathies is worse compared to ischemic cardiomyopathy. Therefore, this study investigates the acute and long-term outcome of multiple ablations in nonischemic cardiomyopathies. Methods: Between January 2016 and July 2022 consecutive patients with VT and nonischemic cardiomyopathies undergoing ablation were included. In total, 249 patients with 400 procedures were included. Procedure endpoints were non-inducibility of the clinical VT (partial success) as well VT non-inducibility (full success). Predictors of VT recurrences and repeat ablation approaches were investigated. Results: The underlying structural heart disease was dilated cardiomyopathy (DCM) in 48%, postmyocarditis in 21%, arrhythmogenic right ventricular disease (ARVC) in 8%, valvular heart disease in 8%, sarcoidosis in 7%, hypertrophic cardiomyopathy (H(o)CM) in 4%, non-compaction cardiomyopathy (NCCM) in 1% and congenital heart disease (CHD) in 1%. Epicardial access was performed in 52% of all cases. A mean of 1.61 ± 1.1 (range 1-8) ablations per patient were performed. Acute partial and full ablation success were 92% and 76%, respectively. Multivariate regression showed no influence of underlying heart disease on acute ablation success. Overall complication rates were acceptable with 14%. Intrahospital mortality was 2%, procedures-related mortality 0.25%. After a mean of 38 ± 21 months VT-free survival after one procedure was 45%, increasing to 64% after multiple procedures. Mean time between ablation and VT recurrence was 225 ± 326 days. Multivariate predictors of VT recurrence during follow-up were presence of electrical storm (HR 1.461, 95% CI 1.256 – 1.992; p=0.027) and myocarditis as underlying heart disease (HR 2.597, 95% CI 1.350 – 4.995; p=0.004). All-cause mortality during follow-up was 17%. Conclusions: Patients with NICM represent a vulnerable patient cohort, however VT ablation is feasible and safe among those patients with satisfying acute and long-term success rates. Especially VT ablations in NICM patients should be reserved to experiences centres with possibility for epicardial access.
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