Long-Term Outcome After Ventricular Tachycardia Ablation in Nonischemic Cardiomyopathy: Late Potential Abolition and VT Noninducibility

Circ Arrhythm Electrophysiol. 2020 Aug;13(8):e008307. doi: 10.1161/CIRCEP.119.008307. Epub 2020 Jul 12.

Abstract

Background: In patients with an ischemic cardiomyopathy (ICM), the combination of late potential (LP) abolition and postprocedural ventricular tachycardia (VT) noninducibility is known to be the desirable end point for a successful long-term outcome after VT ablation. We investigated whether LP abolition and VT noninducibilty have a similar impact on the outcomes of patients with non-ICMs (NICM) undergoing VT ablation.

Methods: A total of 403 patients with NICM (523 procedures) who underwent a VT ablation from 2010 to 2016 were included. The procedure end points were the LP abolition (if the LPs were absent, other ablation strategies were undertaken) and the VT noninducibilty.

Results: The underlying structural heart disease consisted of dilated cardiomyopathy (DCM, 49%), arrhythmogenic right ventricular dysplasia (ARVD, 17%), postmyocarditis (14%), valvular heart disease (8%), congenital heart disease (2%), hypertrophic cardiomyopathy (2%), and others (5%). The epicardial access was performed in 57% of the patients. At baseline, the LPs were present in 60% of the patients and a VT was either inducible or sustained/incessant in 85% of the cases. At the end of the procedure, the LP abolition was achieved in 79% of the cases and VT noninducibility in 80%. After a multivariable analysis, the combination of LP abolition and VT noninducibilty was independently associated with free survival from VT (hazard ratio, 0.45 [95% CI, 0.29-0.69], P=0.0002) and cardiac death (hazard ratio, 0.38 [95% CI, 0.18-0.74], P=0.005). The benefit of the LP abolition on preventing the VT recurrence in patients with ARVD and postmyocarditis appeared superior to that observed for those with DCM.

Conclusions: In patients with NICM undergoing VT ablation, the strategy of LP abolition and VT noninducibilty were associated with better outcomes in terms of long-term VT recurrences and cardiac survival. Graphic Abstract: A graphic abstract is available for this article.

Keywords: arrhythmogenic right ventricular dysplasia; catheter ablation; dilated cardiomyopathy; late potential; myocarditis; ventricular tachycardia.

Publication types

  • Observational Study

MeSH terms

  • Action Potentials*
  • Adult
  • Aged
  • Cardiomyopathies / complications*
  • Cardiomyopathies / diagnosis
  • Cardiomyopathies / physiopathology
  • Catheter Ablation* / adverse effects
  • Female
  • Heart Rate*
  • Humans
  • Male
  • Middle Aged
  • Recurrence
  • Risk Assessment
  • Risk Factors
  • Tachycardia, Ventricular / diagnosis
  • Tachycardia, Ventricular / etiology
  • Tachycardia, Ventricular / physiopathology
  • Tachycardia, Ventricular / surgery*
  • Time Factors
  • Treatment Outcome