Abstract 13369: Comparison of Outcome after Ventricular Tachycardia Ablation in Ischaemic and Non-Ischaemic Cardiomyopathy
Background: Prospective multicenter studies in postinfarct recurrent ventricular tachycardia (VT) reported high effectiveness of VT ablation to control the recurrences and the number of ICD-shocks. Evidences on short and long term effectiveness of VT ablation in non-ischemic cardiomyopathy (NICM) came mostly from small and non-randomised studies. Although the VT ablation in NICM is considered less effective then in ischemic cardiomyopathy (ICM), to date there are no studies comparing the efficacy of the VT ablation in ICM and NICM. This was the aim of our study.
Methods: 237 patients with structural heart disease (206 male, ICM 167 pts. and NICM 70 pts.) after a RF ablation of recurrent sustained VT were included in the study. Patients with ICM were significantly older (67±10 vs. 59±13 years, p < 0.0001). The other basic clinical characteristics between both groups were comparable (LVEF in ICM 32.4 % vs. EF in NICM 34%, p = 0.46). We define the short term success as successful elimination of all (clinical and non-clinical) inducible VTs. The recurrence was defined as every episode of sustained VT, detected in ECG or in ICD ( 92% of the patients have an ICD).
Results: Significantly more patients with NICM required additionally an epicardial ablation ( 28% vs. 1,25%, p > 0.0001). Successful ablation of all VTs was achieved in 73 % in NICM group vs. 78% in ICM, p = 0.40. In the NICM the total procedural time was significantly longer (177 min in NICM vs. 155 min in ICM, p = 0.013); as well as the fluoroscopy time (36 min in NICM vs. 25 min in ICM). After a median follow-up of 16 months we found no difference in the VT recurrence ( 40% in NICM vs. 40% in ICM, p = 1.0) as well as in the time to first VT recurrence (101 days in NICM vs. 115 days in ICM, p= 0.78) in both groups. In the multivariate regression analysis only the LV EDV is an independent predictor of VT recurrence in ICM: exp B = 1.08 ( 95% CI 1.03-1.13), p = 0.002, but not in the NICM group.
Conclusion: In contrast with what we expected, the short and long-term efficacy of RF ablation of VT in non-ischemic cardiomyopathy was comparable with the efficacy in ICM. The significantly longer procedural and fluoroscopy times in NICM group could be explained with the complexity of the procedure in this group.
- © 2012 by American Heart Association, Inc.