SPC365

Predictors of survival and ICD shocks in non-ischemic cardiomyopathy patients submitted to ventricular tachycardia ablation

Session: Posters (Sessão 2 - Écran 2) - Arritmias 2 - Arritmias Ventriculares 1
Speaker: Joao Santos Fonseca

Congress: CPC 2022
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: Pósters Electrónicos
FP Number: ---
Authors: Joao Santos Fonseca; Pedro Silvério António; Sara Couto Pereira; Joana Brito; Beatriz Valente Silva; Pedro Alves da Silva; Ana Beatriz Garcia; Ana Margarida Martins; Catarina Simões de Oliveira; Miguel Azaredo Raposo; Afonso Nunes Ferreira; Gustavo Silva; Luís Carpinteiro; Nuno Cortez-Dias; Fausto j. Pinto; João de Sousa

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><strong><span style="font-size:11.0pt">Introduction: </span></strong></span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><span style="font-size:11.0pt">Patients (pts) with non-ischemic cardiomyopathy (NICM) present an increased morbidity and mortality from s<span style="color:#111111">ustained monomorphic ventricular tachycardia (VT). Implantable cardiac defibrillators effectively terminate VT, but ablation is usually required to prevent recurrences and appropriate shocks. Although several risk factors have been pointed out, clear prognostic predictors need to be established and addressed.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><strong><span style="font-size:11.0pt"><span style="color:#111111">Aim</span></span></strong><span style="font-size:11.0pt"><span style="color:#111111">: To evaluate risk factors associated with all-cause mortality and ICD shocks in NICM pts submitted to VT ablation.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><strong><span style="font-size:11.0pt">Methods: </span></strong><span style="font-size:11.0pt">Prospective, observational, single-centre study of pts with NICM submitted to VT ablation using high density mapping tools. The primary outcome was all-cause death or VT recurrence terminated with appropriate ICD shock during long-term follow up. Kaplan-Meier analysis was used to estimate the long-term event-free survival. Uni and multivariate Cox regression analyses were used to determine relevant prognostic predictors. </span></span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><strong><span style="font-size:11.0pt">Results: </span></strong><span style="font-size:11.0pt">A total of 27 consecutive pts with NICM were referred for a first-ever VT ablation procedure between June 2015 and June 2021 (males: 93%; mean <span style="color:#101010">age: 61&plusmn;12 years). The mean </span>left ventricular ejection fraction (LVEF) <span style="color:#101010">was </span>35&plusmn;12% and 70% of <span style="color:#101010">pts had NYHA class I or II. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><span style="font-size:11.0pt">During a mean follow-up of 29 &plusmn; 19 months, </span>VT recurrences requiring ICD shocks<span style="font-size:11.0pt"> occurred in 25.9% of pts. VT ablation success and the risk of ICD shocks were not associated with any of the clinical characteristics. </span></span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><span style="font-size:11.0pt">Long-term all-cause mortality was 37%. In univariate analysis, LVEF &lt;30%, NT-proBNP, NYHA classification III-IV, chronic kidney disease (CKD), ICD for secondary prevention and prior VT ablation (p=0.08) were associated with reduced survival. On multivariate analysis, CKD was identified as the strongest independent survival predictor (HR 6.9; CI95%: 1.5-23-2, p=0.010)</span></span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><strong><span style="font-size:11.0pt">Conclusions:</span></strong><span style="font-size:11.0pt"> In pts with NIDM, VT ablation may be successful even in pts with advanced heart disease. However, long-term survival will depend mostly on the stage of disease progression and is strongly associated with the clinical markers of end-stage heart failure. Therefore, a timely referral is crucial to derive the best clinical benefit from VT ablation in this population.</span></span></span></p>