TY - JOUR
T1 - Outcomes Associated with Catheter Ablation of Ventricular Tachycardia in Patients with Cardiac Sarcoidosis
AU - Siontis, Konstantinos C.
AU - Santangeli, Pasquale
AU - Muser, Daniele
AU - Marchlinski, Francis E.
AU - Zeppenfeld, Katja
AU - Hoogendoorn, Jarieke C.
AU - Narasimhan, Calambur
AU - Sauer, William H.
AU - Zipse, Matthew M.
AU - Kapa, Suraj
AU - Vedantham, Vasanth
AU - Rosenthal, David G.
AU - Robinson, Melissa R.
AU - Patton, Kristen K.
AU - Murgatroyd, Francis
AU - Chicos, Alexandru B.
AU - Soejima, Kyoko
AU - Roukoz, Henri
AU - Sacher, Frederic
AU - Bhan, Adarsh
AU - Appelbaum, Jason
AU - Dickfeld, Timm
AU - Mankad, Pranav
AU - Ellenbogen, Kenneth A.
AU - Kron, Jordana
AU - Kim, Hyungjin Myra
AU - Froehlich, James
AU - Eagle, Kim A.
AU - Bogun, Frank M.
AU - Crawford, Thomas C.
N1 - Publisher Copyright:
© 2022 American Medical Association. All rights reserved.
PY - 2022/2
Y1 - 2022/2
N2 - Importance: Ventricular tachycardia (VT) is associated with high mortality in patients with cardiac sarcoidosis (CS), and medical management of CS-associated VT is limited by high failure rates. The role of catheter ablation has been investigated in small, single-center studies.Objective: To investigate outcomes associated with VT ablation in patients with CS.Design, Setting, and Participants: This cohort study from the Cardiac Sarcoidosis Consortium registry (2003-2019) included 16 tertiary referral centers in the US, Europe, and Asia. A total of 158 consecutive patients with CS and VT were included (33% female; mean [SD] age, 52 [11] years; 53% with ejection fraction [EF] <50%).Exposures: Catheter ablation of CS-associated VT and, as appropriate, medical treatment.Main Outcomes and Measures: Immediate and short-term outcomes included procedural success, elimination of VT storm, and reduction in defibrillator shocks. The primary long-term outcome was the composite of VT recurrence, heart transplant (HT), or death.Results: Complete procedural success (no inducible VT postablation) was achieved in 85 patients (54%). Sixty-five patients (41%) had preablation VT storm that did not recur postablation in 53 (82%). Defibrillator shocks were significantly reduced from a median (IQR) of 2 (1-5) to 0 (0-0) in the 30 days before and after ablation (P < .001). During median (IQR) follow-up of 2.5 (1.1-4.9) years, 73 patients (46%) experienced VT recurrence and 81 (51%) experienced the composite primary outcome. One- and 2-year rates of survival free of VT recurrence, HT, or death were 60% and 52%, respectively. EF less than 50% and myocardial inflammation on preprocedural 18F-fluorodeoxyglucose positron emission tomography were significantly associated with adverse prognosis in multivariable analysis for the primary outcome (HR, 2.24; 95% CI, 1.37-3.64; P = .001 and HR, 2.93; 95% CI, 1.31-6.55; P = .009, respectively). History of hypertension was associated with a favorable long-term outcome (adjusted HR, 0.51; 95% CI, 0.28-0.92; P = .02).Conclusions and Relevance: In this observational study of selected patients with CS and VT, catheter ablation was associated with reductions in defibrillator shocks and recurrent VT storm. Preablation LV dysfunction and myocardial inflammation were associated with adverse long-term prognosis. These data support the role of catheter ablation in conjunction with medical therapy in the management of CS-associated VT.
AB - Importance: Ventricular tachycardia (VT) is associated with high mortality in patients with cardiac sarcoidosis (CS), and medical management of CS-associated VT is limited by high failure rates. The role of catheter ablation has been investigated in small, single-center studies.Objective: To investigate outcomes associated with VT ablation in patients with CS.Design, Setting, and Participants: This cohort study from the Cardiac Sarcoidosis Consortium registry (2003-2019) included 16 tertiary referral centers in the US, Europe, and Asia. A total of 158 consecutive patients with CS and VT were included (33% female; mean [SD] age, 52 [11] years; 53% with ejection fraction [EF] <50%).Exposures: Catheter ablation of CS-associated VT and, as appropriate, medical treatment.Main Outcomes and Measures: Immediate and short-term outcomes included procedural success, elimination of VT storm, and reduction in defibrillator shocks. The primary long-term outcome was the composite of VT recurrence, heart transplant (HT), or death.Results: Complete procedural success (no inducible VT postablation) was achieved in 85 patients (54%). Sixty-five patients (41%) had preablation VT storm that did not recur postablation in 53 (82%). Defibrillator shocks were significantly reduced from a median (IQR) of 2 (1-5) to 0 (0-0) in the 30 days before and after ablation (P < .001). During median (IQR) follow-up of 2.5 (1.1-4.9) years, 73 patients (46%) experienced VT recurrence and 81 (51%) experienced the composite primary outcome. One- and 2-year rates of survival free of VT recurrence, HT, or death were 60% and 52%, respectively. EF less than 50% and myocardial inflammation on preprocedural 18F-fluorodeoxyglucose positron emission tomography were significantly associated with adverse prognosis in multivariable analysis for the primary outcome (HR, 2.24; 95% CI, 1.37-3.64; P = .001 and HR, 2.93; 95% CI, 1.31-6.55; P = .009, respectively). History of hypertension was associated with a favorable long-term outcome (adjusted HR, 0.51; 95% CI, 0.28-0.92; P = .02).Conclusions and Relevance: In this observational study of selected patients with CS and VT, catheter ablation was associated with reductions in defibrillator shocks and recurrent VT storm. Preablation LV dysfunction and myocardial inflammation were associated with adverse long-term prognosis. These data support the role of catheter ablation in conjunction with medical therapy in the management of CS-associated VT.
KW - Adult
KW - Anti-Arrhythmia Agents/therapeutic use
KW - Cardiomyopathies/complications
KW - Catheter Ablation
KW - Death, Sudden, Cardiac/prevention & control
KW - Defibrillators, Implantable
KW - Electric Countershock/statistics & numerical data
KW - Female
KW - Fluorodeoxyglucose F18
KW - Heart/diagnostic imaging
KW - Heart Transplantation/statistics & numerical data
KW - Humans
KW - Inflammation/diagnostic imaging
KW - Male
KW - Middle Aged
KW - Mortality
KW - Multivariate Analysis
KW - Myocardium
KW - Positron-Emission Tomography
KW - Radiopharmaceuticals
KW - Recurrence
KW - Sarcoidosis/complications
KW - Stroke Volume
KW - Tachycardia, Ventricular/etiology
KW - Treatment Outcome
UR - http://www.scopus.com/inward/record.url?scp=85120076805&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85120076805&partnerID=8YFLogxK
U2 - 10.1001/jamacardio.2021.4738
DO - 10.1001/jamacardio.2021.4738
M3 - Article
C2 - 34787643
AN - SCOPUS:85120076805
SN - 2380-6583
VL - 7
SP - 175
EP - 183
JO - JAMA cardiology
JF - JAMA cardiology
IS - 2
ER -
