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