Outcomes of Catheter Ablation of Ventricular Tachycardia Based on Etiology in Nonischemic Heart Disease

An International Ventricular Tachycardia Ablation Center Collaborative Study

Marmar Vaseghi, Tiffany Y. Hu, Roderick Tung, Pasquale Vergara, David S. Frankel, Luigi Di Biase, Usha B. Tedrow, Jeffrey A. Gornbein, Ricky Yu, Nilesh Mathuria, Shiro Nakahara, Wendy S. Tzou, William H. Sauer, J. David Burkhardt, Venkatakrishna N Tholakanahalli, Timm Michael Dickfeld, J. Peter Weiss, T. Jared Bunch, Madhu Reddy, David J. Callans & 6 others Dhanunjaya R. Lakkireddy, Andrea Natale, Francis E. Marchlinski, William G. Stevenson, Paolo Della Bella, Kalyanam Shivkumar

Research output: Contribution to journalArticle

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Abstract

Objectives: This study sought to characterize ventricular tachycardia (VT) ablation outcomes across nonischemic cardiomyopathy (NICM) etiologies and adjust these outcomes by patient-related comorbidities that could explain differences in arrhythmia recurrence rates. Background: Outcomes of catheter ablation of VT in patients with NICM could be related to etiology of NICM. Methods: Data from 2,075 patients with structural heart disease referred for catheter ablation of VT from 12 international centers was retrospectively analyzed. Patient characteristics and outcomes were noted for the 6 most common NICM etiologies. Multivariable Cox proportional hazards modeling was used to adjust for potential confounders. Results: Of 780 NICM patients (57 ± 14 years of age, 18% women, left ventricular ejection fraction 37 ± 13%), underlying prevalence was 66% for dilated idiopathic cardiomyopathy (DICM), 13% for arrhythmogenic right ventricular cardiomyopathy (ARVC), 6% for valvular cardiomyopathy, 6% for myocarditis, 4% for hypertrophic cardiomyopathy, and 3% for sarcoidosis. One-year freedom from VT was 69%, and freedom from VT, heart transplantation, and death was 62%. On unadjusted competing risk analysis, VT ablation in ARVC demonstrated superior VT-free survival (82%) versus DICM (p ≤ 0.01). Valvular cardiomyopathy had the poorest unadjusted VT-free survival, at 47% (p < 0.01). After adjusting for comorbidities, including age, heart failure severity, ejection fraction, prior ablation, and antiarrhythmic medication use, myocarditis, ARVC, and DICM demonstrated similar outcomes, whereas hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis had the highest risk of VT recurrence. Conclusions: Catheter ablation of VT in NICM is effective. Etiology of NICM is a significant predictor of outcomes, with ARVC, myocarditis, and DICM having similar but superior outcomes to hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis, after adjusting for potential covariates.

Original languageEnglish (US)
Pages (from-to)1141-1150
Number of pages10
JournalJACC: Clinical Electrophysiology
Volume4
Issue number9
DOIs
StatePublished - Sep 1 2018

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Catheter Ablation
Ventricular Tachycardia
Cardiomyopathies
Heart Diseases
Dilated Cardiomyopathy
Arrhythmogenic Right Ventricular Dysplasia
Hypertrophic Cardiomyopathy
Myocarditis
Sarcoidosis
Comorbidity
Recurrence
Survival
Heart Transplantation
Stroke Volume
Cardiac Arrhythmias
Heart Failure

Keywords

  • ablation
  • arrhythmogenic right ventricular cardiomyopathy
  • myocarditis
  • nonischemic
  • sarcoidosis
  • valvular
  • ventricular tachycardia

PubMed: MeSH publication types

  • Journal Article

Cite this

Outcomes of Catheter Ablation of Ventricular Tachycardia Based on Etiology in Nonischemic Heart Disease : An International Ventricular Tachycardia Ablation Center Collaborative Study. / Vaseghi, Marmar; Hu, Tiffany Y.; Tung, Roderick; Vergara, Pasquale; Frankel, David S.; Di Biase, Luigi; Tedrow, Usha B.; Gornbein, Jeffrey A.; Yu, Ricky; Mathuria, Nilesh; Nakahara, Shiro; Tzou, Wendy S.; Sauer, William H.; Burkhardt, J. David; Tholakanahalli, Venkatakrishna N; Dickfeld, Timm Michael; Weiss, J. Peter; Bunch, T. Jared; Reddy, Madhu; Callans, David J.; Lakkireddy, Dhanunjaya R.; Natale, Andrea; Marchlinski, Francis E.; Stevenson, William G.; Della Bella, Paolo; Shivkumar, Kalyanam.

In: JACC: Clinical Electrophysiology, Vol. 4, No. 9, 01.09.2018, p. 1141-1150.

Research output: Contribution to journalArticle

Vaseghi, M, Hu, TY, Tung, R, Vergara, P, Frankel, DS, Di Biase, L, Tedrow, UB, Gornbein, JA, Yu, R, Mathuria, N, Nakahara, S, Tzou, WS, Sauer, WH, Burkhardt, JD, Tholakanahalli, VN, Dickfeld, TM, Weiss, JP, Bunch, TJ, Reddy, M, Callans, DJ, Lakkireddy, DR, Natale, A, Marchlinski, FE, Stevenson, WG, Della Bella, P & Shivkumar, K 2018, 'Outcomes of Catheter Ablation of Ventricular Tachycardia Based on Etiology in Nonischemic Heart Disease: An International Ventricular Tachycardia Ablation Center Collaborative Study', JACC: Clinical Electrophysiology, vol. 4, no. 9, pp. 1141-1150. https://doi.org/10.1016/j.jacep.2018.05.007
Vaseghi, Marmar ; Hu, Tiffany Y. ; Tung, Roderick ; Vergara, Pasquale ; Frankel, David S. ; Di Biase, Luigi ; Tedrow, Usha B. ; Gornbein, Jeffrey A. ; Yu, Ricky ; Mathuria, Nilesh ; Nakahara, Shiro ; Tzou, Wendy S. ; Sauer, William H. ; Burkhardt, J. David ; Tholakanahalli, Venkatakrishna N ; Dickfeld, Timm Michael ; Weiss, J. Peter ; Bunch, T. Jared ; Reddy, Madhu ; Callans, David J. ; Lakkireddy, Dhanunjaya R. ; Natale, Andrea ; Marchlinski, Francis E. ; Stevenson, William G. ; Della Bella, Paolo ; Shivkumar, Kalyanam. / Outcomes of Catheter Ablation of Ventricular Tachycardia Based on Etiology in Nonischemic Heart Disease : An International Ventricular Tachycardia Ablation Center Collaborative Study. In: JACC: Clinical Electrophysiology. 2018 ; Vol. 4, No. 9. pp. 1141-1150.
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abstract = "Objectives: This study sought to characterize ventricular tachycardia (VT) ablation outcomes across nonischemic cardiomyopathy (NICM) etiologies and adjust these outcomes by patient-related comorbidities that could explain differences in arrhythmia recurrence rates. Background: Outcomes of catheter ablation of VT in patients with NICM could be related to etiology of NICM. Methods: Data from 2,075 patients with structural heart disease referred for catheter ablation of VT from 12 international centers was retrospectively analyzed. Patient characteristics and outcomes were noted for the 6 most common NICM etiologies. Multivariable Cox proportional hazards modeling was used to adjust for potential confounders. Results: Of 780 NICM patients (57 ± 14 years of age, 18{\%} women, left ventricular ejection fraction 37 ± 13{\%}), underlying prevalence was 66{\%} for dilated idiopathic cardiomyopathy (DICM), 13{\%} for arrhythmogenic right ventricular cardiomyopathy (ARVC), 6{\%} for valvular cardiomyopathy, 6{\%} for myocarditis, 4{\%} for hypertrophic cardiomyopathy, and 3{\%} for sarcoidosis. One-year freedom from VT was 69{\%}, and freedom from VT, heart transplantation, and death was 62{\%}. On unadjusted competing risk analysis, VT ablation in ARVC demonstrated superior VT-free survival (82{\%}) versus DICM (p ≤ 0.01). Valvular cardiomyopathy had the poorest unadjusted VT-free survival, at 47{\%} (p < 0.01). After adjusting for comorbidities, including age, heart failure severity, ejection fraction, prior ablation, and antiarrhythmic medication use, myocarditis, ARVC, and DICM demonstrated similar outcomes, whereas hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis had the highest risk of VT recurrence. Conclusions: Catheter ablation of VT in NICM is effective. Etiology of NICM is a significant predictor of outcomes, with ARVC, myocarditis, and DICM having similar but superior outcomes to hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis, after adjusting for potential covariates.",
keywords = "ablation, arrhythmogenic right ventricular cardiomyopathy, myocarditis, nonischemic, sarcoidosis, valvular, ventricular tachycardia",
author = "Marmar Vaseghi and Hu, {Tiffany Y.} and Roderick Tung and Pasquale Vergara and Frankel, {David S.} and {Di Biase}, Luigi and Tedrow, {Usha B.} and Gornbein, {Jeffrey A.} and Ricky Yu and Nilesh Mathuria and Shiro Nakahara and Tzou, {Wendy S.} and Sauer, {William H.} and Burkhardt, {J. David} and Tholakanahalli, {Venkatakrishna N} and Dickfeld, {Timm Michael} and Weiss, {J. Peter} and Bunch, {T. Jared} and Madhu Reddy and Callans, {David J.} and Lakkireddy, {Dhanunjaya R.} and Andrea Natale and Marchlinski, {Francis E.} and Stevenson, {William G.} and {Della Bella}, Paolo and Kalyanam Shivkumar",
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TY - JOUR

T1 - Outcomes of Catheter Ablation of Ventricular Tachycardia Based on Etiology in Nonischemic Heart Disease

T2 - An International Ventricular Tachycardia Ablation Center Collaborative Study

AU - Vaseghi, Marmar

AU - Hu, Tiffany Y.

AU - Tung, Roderick

AU - Vergara, Pasquale

AU - Frankel, David S.

AU - Di Biase, Luigi

AU - Tedrow, Usha B.

AU - Gornbein, Jeffrey A.

AU - Yu, Ricky

AU - Mathuria, Nilesh

AU - Nakahara, Shiro

AU - Tzou, Wendy S.

AU - Sauer, William H.

AU - Burkhardt, J. David

AU - Tholakanahalli, Venkatakrishna N

AU - Dickfeld, Timm Michael

AU - Weiss, J. Peter

AU - Bunch, T. Jared

AU - Reddy, Madhu

AU - Callans, David J.

AU - Lakkireddy, Dhanunjaya R.

AU - Natale, Andrea

AU - Marchlinski, Francis E.

AU - Stevenson, William G.

AU - Della Bella, Paolo

AU - Shivkumar, Kalyanam

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Objectives: This study sought to characterize ventricular tachycardia (VT) ablation outcomes across nonischemic cardiomyopathy (NICM) etiologies and adjust these outcomes by patient-related comorbidities that could explain differences in arrhythmia recurrence rates. Background: Outcomes of catheter ablation of VT in patients with NICM could be related to etiology of NICM. Methods: Data from 2,075 patients with structural heart disease referred for catheter ablation of VT from 12 international centers was retrospectively analyzed. Patient characteristics and outcomes were noted for the 6 most common NICM etiologies. Multivariable Cox proportional hazards modeling was used to adjust for potential confounders. Results: Of 780 NICM patients (57 ± 14 years of age, 18% women, left ventricular ejection fraction 37 ± 13%), underlying prevalence was 66% for dilated idiopathic cardiomyopathy (DICM), 13% for arrhythmogenic right ventricular cardiomyopathy (ARVC), 6% for valvular cardiomyopathy, 6% for myocarditis, 4% for hypertrophic cardiomyopathy, and 3% for sarcoidosis. One-year freedom from VT was 69%, and freedom from VT, heart transplantation, and death was 62%. On unadjusted competing risk analysis, VT ablation in ARVC demonstrated superior VT-free survival (82%) versus DICM (p ≤ 0.01). Valvular cardiomyopathy had the poorest unadjusted VT-free survival, at 47% (p < 0.01). After adjusting for comorbidities, including age, heart failure severity, ejection fraction, prior ablation, and antiarrhythmic medication use, myocarditis, ARVC, and DICM demonstrated similar outcomes, whereas hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis had the highest risk of VT recurrence. Conclusions: Catheter ablation of VT in NICM is effective. Etiology of NICM is a significant predictor of outcomes, with ARVC, myocarditis, and DICM having similar but superior outcomes to hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis, after adjusting for potential covariates.

AB - Objectives: This study sought to characterize ventricular tachycardia (VT) ablation outcomes across nonischemic cardiomyopathy (NICM) etiologies and adjust these outcomes by patient-related comorbidities that could explain differences in arrhythmia recurrence rates. Background: Outcomes of catheter ablation of VT in patients with NICM could be related to etiology of NICM. Methods: Data from 2,075 patients with structural heart disease referred for catheter ablation of VT from 12 international centers was retrospectively analyzed. Patient characteristics and outcomes were noted for the 6 most common NICM etiologies. Multivariable Cox proportional hazards modeling was used to adjust for potential confounders. Results: Of 780 NICM patients (57 ± 14 years of age, 18% women, left ventricular ejection fraction 37 ± 13%), underlying prevalence was 66% for dilated idiopathic cardiomyopathy (DICM), 13% for arrhythmogenic right ventricular cardiomyopathy (ARVC), 6% for valvular cardiomyopathy, 6% for myocarditis, 4% for hypertrophic cardiomyopathy, and 3% for sarcoidosis. One-year freedom from VT was 69%, and freedom from VT, heart transplantation, and death was 62%. On unadjusted competing risk analysis, VT ablation in ARVC demonstrated superior VT-free survival (82%) versus DICM (p ≤ 0.01). Valvular cardiomyopathy had the poorest unadjusted VT-free survival, at 47% (p < 0.01). After adjusting for comorbidities, including age, heart failure severity, ejection fraction, prior ablation, and antiarrhythmic medication use, myocarditis, ARVC, and DICM demonstrated similar outcomes, whereas hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis had the highest risk of VT recurrence. Conclusions: Catheter ablation of VT in NICM is effective. Etiology of NICM is a significant predictor of outcomes, with ARVC, myocarditis, and DICM having similar but superior outcomes to hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis, after adjusting for potential covariates.

KW - ablation

KW - arrhythmogenic right ventricular cardiomyopathy

KW - myocarditis

KW - nonischemic

KW - sarcoidosis

KW - valvular

KW - ventricular tachycardia

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DO - 10.1016/j.jacep.2018.05.007

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