Marmar Vaseghi1, Tiffany Y Hu2, Roderick Tung3, Pasquale Vergara4, David S Frankel5, Luigi Di Biase6, Usha B Tedrow7, Jeffrey A Gornbein8, Ricky Yu2, Nilesh Mathuria9, Shiro Nakahara10, Wendy S Tzou11, William H Sauer11, J David Burkhardt12, Venkatakrishna N Tholakanahalli13, Timm-Michael Dickfeld14, J Peter Weiss15, T Jared Bunch15, Madhu Reddy16, David J Callans5, Dhanunjaya R Lakkireddy17, Andrea Natale12, Francis E Marchlinski5, William G Stevenson18, Paolo Della Bella4, Kalyanam Shivkumar2. 1. UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California. Electronic address: mvaseghi@mednet.ucla.edu. 2. UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California. 3. University of Chicago, Chicago, Illinois. 4. Hospital San Raffaele, Milan, Italy. 5. Hospital of the University of Pennsylvania; Philadelphia, Pennsylvania. 6. Albert Einstein College of Medicine at Montefiore Hospital, Bronx, New York. 7. Brigham and Women's Hospital, Boston, Massachusetts. 8. Department of Biostatistics, University of California, Los Angeles, Los Angeles, California. 9. Baylor St. Luke's Medical Center/Texas Heart Institute, Houston, Texas. 10. Dokkyo Medical University Koshigaya Hospital, Saitama, Japan. 11. University of Colorado, Aurora, Colorado. 12. Texas Cardiac Arrhythmia Institute, St. David's Medical Center; Austin, Texas. 13. University of Minnesota Medical Center, Minneapolis VA Medical Center, Minneapolis, Minnesota. 14. University of Maryland Medical Center, Baltimore, Maryland. 15. Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah. 16. University of Kansas Medical Center, Kansas City, Kansas. 17. Overland Park Regional Medical Center, HCA Midwest Health, Overland Park, Kansas City, Kansas. 18. Vanderbilt University, Nashville, Tennessee.
Abstract
OBJECTIVES: This study sought to characterize ventricular tachycardia (VT) ablation outcomes across nonischemic cardiomyopathy (NICM) etiologies and adjust these outcomes by patient-related comorbidities that could explain differences in arrhythmia recurrence rates. BACKGROUND: Outcomes of catheter ablation of VT in patients with NICM could be related to etiology of NICM. METHODS: Data from 2,075 patients with structural heart disease referred for catheter ablation of VT from 12 international centers was retrospectively analyzed. Patient characteristics and outcomes were noted for the 6 most common NICM etiologies. Multivariable Cox proportional hazards modeling was used to adjust for potential confounders. RESULTS: Of 780 NICM patients (57 ± 14 years of age, 18% women, left ventricular ejection fraction 37 ± 13%), underlying prevalence was 66% for dilated idiopathic cardiomyopathy (DICM), 13% for arrhythmogenic right ventricular cardiomyopathy (ARVC), 6% for valvular cardiomyopathy, 6% for myocarditis, 4% for hypertrophic cardiomyopathy, and 3% for sarcoidosis. One-year freedom from VT was 69%, and freedom from VT, heart transplantation, and death was 62%. On unadjusted competing risk analysis, VT ablation in ARVC demonstrated superior VT-free survival (82%) versus DICM (p ≤ 0.01). Valvular cardiomyopathy had the poorest unadjusted VT-free survival, at 47% (p < 0.01). After adjusting for comorbidities, including age, heart failure severity, ejection fraction, prior ablation, and antiarrhythmic medication use, myocarditis, ARVC, and DICM demonstrated similar outcomes, whereas hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis had the highest risk of VT recurrence. CONCLUSIONS: Catheter ablation of VT in NICM is effective. Etiology of NICM is a significant predictor of outcomes, with ARVC, myocarditis, and DICM having similar but superior outcomes to hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis, after adjusting for potential covariates.
OBJECTIVES: This study sought to characterize ventricular tachycardia (VT) ablation outcomes across nonischemic cardiomyopathy (NICM) etiologies and adjust these outcomes by patient-related comorbidities that could explain differences in arrhythmia recurrence rates. BACKGROUND: Outcomes of catheter ablation of VT in patients with NICM could be related to etiology of NICM. METHODS: Data from 2,075 patients with structural heart disease referred for catheter ablation of VT from 12 international centers was retrospectively analyzed. Patient characteristics and outcomes were noted for the 6 most common NICM etiologies. Multivariable Cox proportional hazards modeling was used to adjust for potential confounders. RESULTS: Of 780 NICM patients (57 ± 14 years of age, 18% women, left ventricular ejection fraction 37 ± 13%), underlying prevalence was 66% for dilated idiopathic cardiomyopathy (DICM), 13% for arrhythmogenic right ventricular cardiomyopathy (ARVC), 6% for valvular cardiomyopathy, 6% for myocarditis, 4% for hypertrophic cardiomyopathy, and 3% for sarcoidosis. One-year freedom from VT was 69%, and freedom from VT, heart transplantation, and death was 62%. On unadjusted competing risk analysis, VT ablation in ARVC demonstrated superior VT-free survival (82%) versus DICM (p ≤ 0.01). Valvular cardiomyopathy had the poorest unadjusted VT-free survival, at 47% (p < 0.01). After adjusting for comorbidities, including age, heart failure severity, ejection fraction, prior ablation, and antiarrhythmic medication use, myocarditis, ARVC, and DICM demonstrated similar outcomes, whereas hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis had the highest risk of VT recurrence. CONCLUSIONS: Catheter ablation of VT in NICM is effective. Etiology of NICM is a significant predictor of outcomes, with ARVC, myocarditis, and DICM having similar but superior outcomes to hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis, after adjusting for potential covariates.
Authors: W G Stevenson; P L Friedman; P T Sager; L A Saxon; D Kocovic; T Harada; I Wiener; H Khan Journal: J Am Coll Cardiol Date: 1997-05 Impact factor: 24.094
Authors: Saurabh Kumar; Jorge Romero; Nishaki K Mehta; Akira Fujii; Sunil Kapur; Samuel H Baldinger; Chirag R Barbhaiya; Bruce A Koplan; Roy M John; Laurence M Epstein; Gregory F Michaud; Usha B Tedrow; William G Stevenson Journal: Heart Rhythm Date: 2016-07-05 Impact factor: 6.343
Authors: Saurabh Kumar; Chirag Barbhaiya; Koichi Nagashima; Eue-Keun Choi; Laurence M Epstein; Roy M John; Melanie Maytin; Christine M Albert; Amy L Miller; Bruce A Koplan; Gregory F Michaud; Usha B Tedrow; William G Stevenson Journal: Circ Arrhythm Electrophysiol Date: 2014-12-19
Authors: John L Sapp; George A Wells; Ratika Parkash; William G Stevenson; Louis Blier; Jean-Francois Sarrazin; Bernard Thibault; Lena Rivard; Lorne Gula; Peter Leong-Sit; Vidal Essebag; Pablo B Nery; Stanley K Tung; Jean-Marc Raymond; Laurence D Sterns; George D Veenhuyzen; Jeff S Healey; Damian Redfearn; Jean-Francois Roux; Anthony S L Tang Journal: N Engl J Med Date: 2016-05-05 Impact factor: 91.245
Authors: Duy T Nguyen; Wendy S Tzou; Michael Brunnquell; Matthew Zipse; Joseph L Schuller; Lijun Zheng; Ryan A Aleong; William H Sauer Journal: Heart Rhythm Date: 2016-07-14 Impact factor: 6.343
Authors: Pasquale Santangeli; Erica S Zado; Gregory E Supple; Haris M Haqqani; Fermin C Garcia; Cory M Tschabrunn; David J Callans; David Lin; Sanjay Dixit; Mathew D Hutchinson; Michael P Riley; Francis E Marchlinski Journal: Circ Arrhythm Electrophysiol Date: 2015-11-06
Authors: Philippe Maury; Francesca Baratto; Katja Zeppenfeld; George Klein; Etienne Delacretaz; Frederic Sacher; Etienne Pruvot; Francois Brigadeau; Anne Rollin; Marius Andronache; Giuseppe Maccabelli; Marcin Gawrysiak; Roman Brenner; Andrei Forclaz; Jürg Schlaepfer; Dominique Lacroix; Alexandre Duparc; Pierre Mondoly; Frederic Bouisset; Marc Delay; Meleze Hocini; Nicolas Derval; Nicolas Sadoul; Isabelle Magnin-Poull; Didier Klug; Michel Haïssaguerre; Pierre Jaïs; Paolo Della Bella; Christian De Chillou Journal: Eur Heart J Date: 2014-02-16 Impact factor: 29.983
Authors: Justin Hayase; Veronica Dusi; Duc Do; Olujimi A Ajijola; Marmar Vaseghi; Jay M Lee; Jane Yanagawa; Nir Hoftman; Sha'Shonda Revels; Eric F Buch; Houman Khakpour; Osamu Fujimura; Yuliya Krokhaleva; Carlos Macias; Julie Sorg; Jean Gima; Geraldine Pavez; Noel G Boyle; Kalyanam Shivkumar; Jason S Bradfield Journal: J Cardiovasc Electrophysiol Date: 2020-06-30
Authors: Edmond M Cronin; Frank M Bogun; Philippe Maury; Petr Peichl; Minglong Chen; Narayanan Namboodiri; Luis Aguinaga; Luiz Roberto Leite; Sana M Al-Khatib; Elad Anter; Antonio Berruezo; David J Callans; Mina K Chung; Phillip Cuculich; Andre d'Avila; Barbara J Deal; Paolo Della Bella; Thomas Deneke; Timm-Michael Dickfeld; Claudio Hadid; Haris M Haqqani; G Neal Kay; Rakesh Latchamsetty; Francis Marchlinski; John M Miller; Akihiko Nogami; Akash R Patel; Rajeev Kumar Pathak; Luis C Saenz Morales; Pasquale Santangeli; John L Sapp; Andrea Sarkozy; Kyoko Soejima; William G Stevenson; Usha B Tedrow; Wendy S Tzou; Niraj Varma; Katja Zeppenfeld Journal: J Interv Card Electrophysiol Date: 2020-10 Impact factor: 1.900
Authors: Edmond M Cronin; Frank M Bogun; Philippe Maury; Petr Peichl; Minglong Chen; Narayanan Namboodiri; Luis Aguinaga; Luiz Roberto Leite; Sana M Al-Khatib; Elad Anter; Antonio Berruezo; David J Callans; Mina K Chung; Phillip Cuculich; Andre d'Avila; Barbara J Deal; Paolo Della Bella; Thomas Deneke; Timm-Michael Dickfeld; Claudio Hadid; Haris M Haqqani; G Neal Kay; Rakesh Latchamsetty; Francis Marchlinski; John M Miller; Akihiko Nogami; Akash R Patel; Rajeev Kumar Pathak; Luis C Sáenz Morales; Pasquale Santangeli; John L Sapp; Andrea Sarkozy; Kyoko Soejima; William G Stevenson; Usha B Tedrow; Wendy S Tzou; Niraj Varma; Katja Zeppenfeld Journal: Europace Date: 2019-08-01 Impact factor: 5.214
Authors: Jens Cosedis Nielsen; Yenn-Jiang Lin; Marcio Jansen de Oliveira Figueiredo; Alireza Sepehri Shamloo; Alberto Alfie; Serge Boveda; Nikolaos Dagres; Dario Di Toro; Lee L Eckhardt; Kenneth Ellenbogen; Carina Hardy; Takanori Ikeda; Aparna Jaswal; Elizabeth Kaufman; Andrew Krahn; Kengo Kusano; Valentina Kutyifa; Han S Lim; Gregory Y H Lip; Santiago Nava-Townsend; Hui-Nam Pak; Gerardo Rodríguez Diez; William Sauer; Anil Saxena; Jesper Hastrup Svendsen; Diego Vanegas; Marmar Vaseghi; Arthur Wilde; T Jared Bunch; Alfred E Buxton; Gonzalo Calvimontes; Tze-Fan Chao; Lars Eckardt; Heidi Estner; Anne M Gillis; Rodrigo Isa; Josef Kautzner; Philippe Maury; Joshua D Moss; Gi-Byung Nam; Brian Olshansky; Luis Fernando Pava Molano; Mauricio Pimentel; Mukund Prabhu; Wendy S Tzou; Philipp Sommer; Janice Swampillai; Alejandro Vidal; Thomas Deneke; Gerhard Hindricks; Christophe Leclercq Journal: Europace Date: 2020-08-01 Impact factor: 5.214
Authors: Veronica Dusi; Jeffrey Gornbein; Duc H Do; Julie M Sorg; Houman Khakpour; Yuliya Krokhaleva; Olujimi A Ajijola; Carlos Macias; Jason S Bradfield; Eric Buch; Osamu A Fujimura; Noel G Boyle; Jane Yanagawa; Jay M Lee; Kalyanam Shivkumar; Marmar Vaseghi Journal: J Am Heart Assoc Date: 2021-01-14 Impact factor: 5.501
Authors: Erick A Perez-Alday; Kazi T Haq; David M German; Christopher Hamilton; Kyle Johnson; Francis Phan; Nichole M Rogovoy; Katherine Yang; Ashley Wirth; Jason A Thomas; Khidir Dalouk; Cristina Fuss; Maros Ferencik; Stephen Heitner; Larisa G Tereshchenko Journal: Front Physiol Date: 2020-04-24 Impact factor: 4.566
Authors: Indranill Basu-Ray; Dibbendhu Khanra; Sumit K Shah; Anindya Mukherjee; Sudhanva V Char; Bhavna Jain; T Jared Bunch; Michael Gold; Adedayo A Adeboye; Mohammad Saeed Journal: Pacing Clin Electrophysiol Date: 2020-11-30 Impact factor: 1.976