SPC365

Ventricular tachycardia ablation in nonischemic cardiomyopathy

Session: CO 16 - Morte Súbita
Speaker: Daniel Jorge Nascimento Matos

Congress: CPC 2021
Topic: C. Arrhythmias and Device Therapy
Theme: 08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme: 08.4 Ventricular Arrhythmias and SCD - Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: Daniel Nascimento Matos; Diogo Cavaco; Pedro Carmo; Maria Salomé Carvalho; Gustavo Rodrigues; João Carmo; Pedro Galvão Santos; Francisco Costa; Miguel Mendes; Francisco Morgado; Pedro Adragão

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">INTRODUCTION:</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Arial&quot;,sans-serif">Catheter ablation outcomes for ventricular tachycardia (VT) in nonischemic cardiomyopathy (NICM) are suboptimal when compared to ischemic cardiomyopathy. We aimed to analyse the long-term efficacy and safety of percutaneous catheter ablation in this subset of patients.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">METHODS</span></strong><span style="font-family:&quot;Arial&quot;,sans-serif">:</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Arial&quot;,sans-serif">Single-center observational retrospective registry including consecutive NICM patients who underwent catheter ablation for&nbsp;VT during a 10-year period. The efficacy endpoint was defined as VT-free survival after catheter ablation, while safety outcomes were defined by 30-days mortality and procedure-related complications. Independent predictors of VT recurrence were assessed by Cox regression.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">RESULTS:</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Arial&quot;,sans-serif">In a population of 68 patients, most were male (85%), mean </span><span style="font-family:&quot;Arial&quot;,sans-serif">left ventricular ejection fraction (LVEF) was </span><span style="font-family:&quot;Arial&quot;,sans-serif">34 &plusmn; 12%, </span><span style="font-family:&quot;Arial&quot;,sans-serif">and mea</span><span style="font-family:&quot;Arial&quot;,sans-serif">n age was 58 &plusmn; 15 years. All patients had an </span><span style="background-color:white"><span style="font-family:&quot;Helvetica&quot;,sans-serif"><span style="color:#111111">implantable cardioverter-defibrillator. </span></span></span><span style="font-family:&quot;Arial&quot;,sans-serif">Twenty-six (38%) patients underwent epicardial ablation (table 1). </span><span style="font-family:&quot;Arial&quot;,sans-serif">Over a median follow-up of 3 years (IQR 1-8), 41% (n=31) patients had VT recurrence and 28% died (n=19). Multivariate survival analysis identified LVEF (HR= 0.98; 95%CI 0.92-0.99, p=0.046) and VT storm at presentation (HR=2.38; 95%CI 1.04-5.46, p=0.041) as independent predictors of VT recurrence. The yearly rates of VT recurrence and overall mortality were 21%/year and 10%/year, respectively. No patients died at 30-days post-procedure, and mean hospital length of stay was 5 </span><span style="font-family:&quot;Arial&quot;,sans-serif">&plusmn; 6 days. The complication rate was 7% (n=5, table 1), mostly in patients undergoing epicardial ablation (4 vs 1 in endocardial ablation, P = 0.046).</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">CONCLUSION:</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Arial&quot;,sans-serif">LVEF and VT storm at presentation were independent predictors of VT recurrence in NICM patients after catheter ablation. While clinical outcomes can be improved with further technical and scientific development, a tailored endocardial/epicardial approach was safe, with low overall number of complications and no 30-days mortality.</span></span></span></p>