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Circulation: Arrhythmia and Electrophysiology
Although VT ablation can be challenging in nonischemic cardiomyopathy, this large series shows that ablation, which requires epicardial ablation in about a third of patients, can usually reduce recurrent ventricular tachycardia.
Long-Term Outcome After Catheter Ablation of Ventricular Tachycardia in Patients With Nonischemic Dilated Cardiomyopathy
Daniele Muser, MD, Pasquale Santangeli, MD, PhD, Simon A. Castro, MD, Rajeev K. Pathak, MBBS, PhD, Jackson J. Liang, DO, Tatsuya Hayashi, MD, Silvia Magnani, MD, Fermin C. Garcia, MD, Mathew D. Hutchinson, MD, Gregory G. Supple, MD, David S. Frankel, MD, Michael P. Riley, MD, PhD, David Lin, MD, Robert D. Schaller, DO, Sanjay Dixit, MD, Erica S. Zado, PA-C, David J. Callans, MD, Francis E. Marchlinski, MD
Correspondence to: Francis Marchlinski, MD, Hospital of the University of Pennsylvania, 9 Founders Pavilion–Cardiology, 3400 Spruce St, Philadelphia, PA 19104. E-mail email@example.com
BACKGROUND: Catheter ablation (CA) of ventricular tachycardia (VT) in patients with nonischemic dilated cardiomyopathy can be challenging because of the complexity of underlying substrates. We sought to determine the long-term outcomes of endocardial and adjuvant epicardial CA in nonischemic dilated cardiomyopathy.
METHODS AND RESULTS: We examined 282 consecutive patients (aged 59±15 years, 80% males) with nonischemic dilated cardiomyopathy who underwent CA. Ablation was guided by activation/entrainment mapping for tolerated VT and pacemapping/targeting of abnormal electrograms for unmappable VT. Adjuvant epicardial ablation was performed for recurrent VT or persistent inducibility after endocardial–only ablation. Epicardial ablation was performed in 90 (32%) patients. Before ablation, patients failed a median of 2 antiarrhythmic drugs), including amiodarone, in 166 (59%) patients. The median follow-up after the last procedure was 48 (19–67) months. Overall, VT-free survival was 69% at 60-month follow-up. Transplant-free survival was 76% and 68% at 60- and 120-month follow-up, respectively. Among the 58 (21%) patients with VT recurrence, CA still resulted in a significant reduction of VT burden, with 31 (53%) patients having only isolated (1–3) VT episodes in 12 (4–35) …