SPC365

Ventricular tachycardia ablation in patients with ischaemic and non-ischaemic cardiomyopathy

Session: Posters (Sessão 6 - Écran 2) - Arrítmias 6 - Arrítmias Ventriculares 2
Speaker: Pedro Silvério António

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: Pedro Silvério António; Joana Brito; Sara Couto Pereira; Pedro Alves da Silva; Beatriz Valente Silva; Catarina Oliveira; Beatriz Garcia; Margarida Martins; Miguel Raposo; Afonso Nunes-Ferreira; Gustavo Lima da Silva; Luis Carpinteiro; Nuno Cortez-Dias; Fausto J.Pinto; João de Sousa

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">:&nbsp; Ventricular tachycardia (VT) is frequently in the setting of structural heart disease &ndash; ischaemic cardiomyopathy (ICM) or non-ischaemic cardiomyopathy (NICM). Radiofrequency catheter ablation (RCA) is an effective treatment for VT in ICM, but the results in NICM patients are not so satisfactory, and studies comparing efficacy are limited.</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Aim</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: To report the description and long-term outcome after a single RCA procedure for VT in patients with ICM and 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"><span style="color:#000000"><strong>Methods:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> We conducted a prospective, observational, single-centre and single-arm study involving patients with ICM and NICM, referred for RCA procedure for VT using high-density mapping catheters. Procedural endpoints were VT noninducibility and abolition of local abnormal ventricular activities (LAVAs). Primary end-point was a composite of all-cause mortality, recurrence of VT and heart failure hospitalization. Secondary end-point was survival-free from appropriate ICD shocks.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: We included 102 patients (94.1% males, mean age 67 &plusmn; 11, mean follow-up of 2.6 &plusmn; 1.7 years), 73.5% had ischemic aetiology and 26.5% NICM. Patients had a mean LVEF 33.9% &plusmn; 11.3% and 50% were in NYHA II class. Baseline characteristics were similar between two groups, except that NICM patients were younger (mean age 61&plusmn;12 vs 69&plusmn;9, p=0.001) and ICM patients had more hypertension, smoking habits (p=0.001) and chronic kidney disease (58.8ml/min vs 71.7ml/min, p= 0.039).&nbsp; At time of ablation 47% patients presented with arrhythmic storm and 62% with ICD-shock. LAVAs were identified in all patients and sustained monomorphic VT was inducible in 41%.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">LAVAs elimination and noninducibility were achieved in 93.8% and 60%, respectively in ICM and NICM.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">At 1-year 55% were free from the primary composite end-point irrespective of aetiology (ICM 60% vs NICM 43%) and 33% at 2-year (ICM 36% vs NICM 29%), p= 0.135. Freedom from appropriate ICD shocks was 91% at 1-year (91% ICM vs 92% NICM) and 86% at 2-year (85.5% ICM vs 86% NICM), p= 0.358. Overall survival was 86% and 83% at 1 and 2 years, respectively.</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"><span style="color:#000000"><strong>Conclusions:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> In patients submitted to RCA of VT using a high-density mapping substrate-based approach the long-term success rate was similar in both ICM and NICM, namely in long-term freedom from ICD shocks or cardiovascular hospitalizations.</span></span></span></p>

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