SPC365

Ventricular Tachycardia Ablation in Non-ischemic Cardiomyopathy

Session: Posters (Sessão 5 - Écran 2) - Arritmias 5 - Foco na Insuficiência Cardíaca
Speaker: Joana Brito

Congress: CPC 2022
Topic: C. Arrhythmias and Device Therapy
Theme: 08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme: 08.6 Ventricular Arrhythmias and SCD - Clinical
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Joana Brito; Pedro Silvério António; Sara Couto Pereira; Beatriz Valente Silva; Pedro Alves da Silva; Ana Margarida Martins; Catarina Simões de Oliveira; Afonso Nunes Ferreira; Gustavo Lima Silva; Patrícia Teixeira; Luís Carpinteiro; Nuno Cortez-Dias; Fausto j. Pinto; João de Sousa

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong>: Non-ischemic cardiomyopathies (NICM) is a heterogeneous group of diseases of the myocardium, which ventricular dilatation, systolic impairment or hypertrophy can occur. Most frequent etiologies described in studies are dilated idiopathic cardiomyopathy (DCM) 55-66% and arrhythmogenic right ventricular cardiomyopathy (ARVC) 5-13%. Radiofrequency catheter ablation (RCA) is being increasingly performed as adjunctive treatment to implantable cardioverter-defibrillator (ICD) in NICM patients (pts) and refractory ventricular tachycardia (VT). Despite, some recent studies shown that RCA in NICM patients have similar VT recurrence and death results compare to Ischemic cardiomyopathy (ICM), the best approach is not well establish.</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Aim</span></strong><span style="color:black">: To report the safety and the long-term outcome after a single RCA procedure for VT in pts with NICM using a high-density substrate-based approach.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> We conducted a prospective, observational, single-centre and single-arm study involving pts with NICM, referred for RCA procedure for VT using high-density mapping catheters. Procedural endpoints were VT noninducibility and local abnormal ventricular activities (LAVAs). Intraprocedural complications were analysed. Primary end-point was a composite of all-cause mortality, recurrence of VT and heart transplantation. Secondary end-point was survival free from appropriate ICD shocks.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Results</span></strong><span style="color:black">:</span> A total of 27 pts were included (92.6% males, mean age 60.6 &plusmn; 12, mean LVEF 34.8% &plusmn; 12.3%, mean NTproBNP 3400 &plusmn; 3700) and 78% with ICD and/or CRT-D. Major cardiovascular risk factors were HTN (37%) and smoker or ex-smoker (44.4%). The most prevalent etiology was DCM (67%).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The epicardial access was the most common approach in 16 patients (59.3%). <span style="color:black">LAVAs were identified in all patients and sustained monomorphic VT was induced in 83%. LAVAs elimination and noninducibility were achieved in 85.2% and 60%, respectively. </span>The overall complication rate was 14.7% and procedure-related death occurred in one case (3.7%). The commonest complications were pericardial effusion 7.4%, phrenic lesion in 3.7% and cardiogenic shock in 3.7%.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">After a mean follow-up of 28.7 <span style="color:black">&plusmn; 19.1 months, 10 (37%) pts died, 9 (34%) had cardiovascular admissions, 3 patients underwent cardiac transplant. A total of 7 (26%) pts received an appropriate shock of which 3 with arrhythmic storm and were referred to redo procedure. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Freedom from the primary end-point was 56% and 50% pts at 1-year and 2-year, respectively, and freedom from appropriate ICD-shock was 91% and 81% at 1 and 2 years.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Conclusion</span></strong><span style="color:black">: </span><span style="color:black">RCA of VT using a high-density mapping substrate-based approach is safety and effective by reducing the ICD shocks. According to the worst prognosis of this population, the results of RCA in mortality and heart transplantation are moderate. Larger studies are needed to evaluate the results of RCA in NICM pts.</span></span></span></p>