Outcomes in Catheter Ablation of Ventricular Tachycardia in Dilated Non-Ischemic Cardiomyopathy in Comparison to Ischemic Cardiomyopathy: Results from the Prospective HEart Centre of LeiPzig VT (HELP - VT) Study
Background—Data on the outcomes of ventricular tachycardia (VT) ablation in non-ischemic dilated cardiomyopathy (NIDCM) are insufficient. The HEart centre of LeiPzig VT (HELP-VT) study was prospectively conducted to compare outcomes after radiofrequency catheter ablation (RFCA) of VT in patients with NIDCM as compared to ischemic cardiomyopathy (ICM).
Methods and Results—Two hundred and twenty-seven (227) patients with NIDCM (63 pts.) and ICM (164 pts.), presenting with sustained VT were ablated using RFCA. Non-inducibility of any clinical and non-clinical VT was achieved in 66.7% in NIDCM and in 77.4% in ICM. Ablation of the clinical VT only was achieved in 18.3% in ICM and in 22.2% in DCM. There was no statistically significant difference in the acute outcome between the two groups. At one year follow-up, the VT free survival in NIDCM was 40.5% versus 57% in ICM. In univariate analysis, the hazard ratio for VT recurrence was significantly higher for the NIDCM (HR 1.62; CI 95% 1.12- 2.34; p = 0.01). In both ICM and NIDCM subgroups, the procedure failure and incomplete procedural success were independent predictors for VT recurrence.
Conclusions—Even though the acute success after VT ablation in NIDCM and ICM was similar, the long-term outcomes in NIDCM were significantly worse. Complete VT non-inducibility at the end of the ablation associates with beneficial long-term outcome in NIDCM. Pursuing compete elimination of all inducible VTs is desirable and may improve the long-term success in NIDCM.
- Received April 5, 2013.
- Revision received October 24, 2013.
- Accepted October 31, 2013.