Abstract 11158: The Role of Repeat Procedures for Catheter Ablation of Ventricular Tachycardia with Non-Ischemic Cardiomyopathy
Background In patients with non-ischemic cardiomyopathy (NICM), ventricular tachycardia (VT) is associated with increased mortality and morbidity. Catheter ablation is useful for reducing VT therapies but remains challenging. The role of repeat catheter ablation when VT recurs has not been defined. This study assesses the outcome of patients having repeat catheter ablation procedures for VT due to NICM.
Methods From a total of 241 consecutive patients undergoing ablation for VT due to NICM, 93 patients having a repeat procedure after prior failed catheter ablation procedures (PFCA group) were compared to 148 patients who underwent a single catheter ablation in the same study period (SCA group).
Results Of the PFCA group, 58 (62%) had one procedure and 35 (38%) had two or more prior ablations. PFCA group was younger (49 ± 13 vs. 54 ± 14 years; P=0.007), had failed more anti-arrhythmic drugs (2.9 ± 1.5 vs. 2.2 ± 1.2; P<0.001) and underwent more frequent epicardial ablation (46% vs. 11%; P<0.001) than SCA group. Periprocedural complications were more frequent in the PFCA than the SCA group (9.7% vs. 3.4%, p=0.04). In PFCA group, 3 of 9 complications related to epicardial ablation; ventricular puncture during percutaneous pericardiocentesis in 2, delayed myocardial infarction in 1. Over a mean follow up of 4.2 ± 3.6 years, VT recurrence (P=0.21) and mortality (P=0.46) were not significantly different between the groups (Figure). In Cox proportional hazards models older age and greater number of induced VTs were predictors of mortality after repeat ablation (HR 1.129; 95% CI 1.033-1.233; P=0.007 and HR 1.837, 95% CI 1.107-3.047; P=0.02).
Conclusions In NICM patients with VT failure of initial ablation does not preclude subsequent successful ablation. VT recurrences are similar, but patients with prior ablation may have greater risk for procedural complications.
- © 2011 by American Heart Association, Inc.