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Santoro F, Metzner A, Scholz L, Brunetti ND, Heeger CH, Rillig A, Reissmann B, Lemeš C, Maurer T, Fink T, Inaba O, Hashiguchi N, Kuck KH, Ouyang F, Mathew S. Prognostic significance of ventricular tachycardia clustering after catheter ablation in non-ischemic dilated cardiomyopathy. Clin Res Cardiol 2018; 108:539-548. [PMID: 30350253 DOI: 10.1007/s00392-018-1384-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 10/15/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Ventricular tachycardia clustering (VTc) is associated with a worse clinical outcome in patients with non-ischemic dilated cardiomyopathy (NI-DCM) and implantable cardioverter defibrillator (ICD); however, its role after catheter ablation (CA) has still not been investigated. Aim of this study was to evaluate the prognostic significance of VTc after CA. METHODS 96 consecutive patients (59 ± 13 years, 82% males) with NI-DCM underwent CA for drug-refractory VT. After CA, patients with VT recurrence were divided into two groups: (1) patients that presented with VTc defined as the occurrence of three or more appropriate ICD interventions within 2 weeks, and (2) patients without VTc. RESULTS At 56-months follow-up after ablation 52/96 (54%) patients had recurrent VT, 28/52 (54%) patients experienced VTc and 24/52 (46%) no VTc. When comparing patients with VTc after CA with those without, no differences in terms of age, sex, ejection fraction and cardiovascular risk factors were found. However, patients with VTc showed higher mortality rates at follow-up (54% vs 21% p = 0.04; log-rank p ≤ 0.01). No survival differences were found between patients without VT recurrence and those with VT recurrence but without VTc (29% vs 21% p = 0.77). Predictors of VTc were LVEF < 30% at follow-up and endo-epicardial scar at 3D voltage mapping. At stepwise multivariate analysis VTc and NHYA class were the only independent predictors of death (respectively, RR 3.4, CI 95% 1.16-10.3, p = 0.02; RR 4.18, CI 95% 1.3-12.6, p = 0.01). CONCLUSIONS VTc after CA is an independent predictor of survival and is associated with reduced LVEF at follow-up and endo-epicardial scar at 3D voltage mapping.
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Affiliation(s)
- Francesco Santoro
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany. .,Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
| | - Andreas Metzner
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Leonie Scholz
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | | | - Christian-H Heeger
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany.,University Heart Center Lübeck, Lübeck, Germany
| | - Andreas Rillig
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Bruno Reissmann
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Christine Lemeš
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Tilmann Maurer
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Thomas Fink
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Osamu Inaba
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Naotaka Hashiguchi
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Feifan Ouyang
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Shibu Mathew
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
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