Abstract 14663: Mechanisms of Ventricular Tachycardia Recurrence and Outcomes of Repeat Catheter Ablation After Cardiac Sympathetic Denervation in Nonischemic Cardiomyopathy Patients
Background: Cardiac sympathetic denervation (CSD) is a useful adjunct for treatment of ventricular tachycardia (VT). The mechanisms of VT recurrence after CSD and outcomes of repeat catheter ablation have not been examined.
Methods: Retrospective analysis was performed for nonischemic cardiomyopathy (NICM) patients (pts) who underwent repeat VT ablation after CSD. Electrograms (EGM) and electroanatomic mapping (EAM) data from ablation procedures before and after CSD were analyzed for VT morphologies and late potentials (LPs). Outcomes were analyzed for the ablation after CSD.
Results: Among 31 NICM pts undergoing CSD (4/09-12/12), 7 (4 bilateral / 3 left CSD) (TABLE) underwent ablation after CSD (median 33 days after CSD), of which 6 had complete EGM and EAM data before and after CSD. The mean age is 59±9 yrs, EF 34±13%, and 86% pts had previously undergone combined epicardial-endocardial mapping/ablation. In 5/6 pts, all VTs induced during the repeat ablation (mean 3.9±2.3 VTs / pt) were new, compared to VTs induced during the ablation prior to CSD. New LPs were detected after CSD in 2/6 pts, despite an absence of LPs during extensive mapping of the same surface previously. For 1 pt, a new apical endocardial scar (19 cm2), absent on prior endocardial mapping, was detected after CSD, and was the origin of a new VT morphology. Ablation after CSD eliminated the clinical VT for 86% pts and all VTs for 43%. However, within 1 yr, 86% pts experienced VT recurrence, and 43% required orthotopic heart transplant (OHT) or were deceased.
Conclusion: New LPs or scar were revealed in 43% of NICM pts undergoing repeat ablation for recurrent VT after CSD, and 83% exhibited only new VT morphologies. This suggests that although CSD reduces the burden of VT, in few cases, the underlying cardiomyopathy progresses, leading to new arrhythmogenic substrate for VT. In these pts, 1-yr outcomes are poor, with VT recurrence rate at 86% and OHT/mortality at 43%.
Author Disclosures: R. Yu: None. M. Vaseghi: None. O.A. Ajijola: None. R. Tung: None. N.G. Boyle: None. K. Shivkumar: None.
- © 2016 by American Heart Association, Inc.