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Prognostic significance of ventricular tachycardia clustering after catheter ablation in non-ischemic dilated cardiomyopathy

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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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Author notes

  1. Francesco Santoro and Andreas Metzner contributed equally and should both be considered as first authors.

Authors and Affiliations

  1. Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany

    Francesco Santoro, Andreas Metzner, Leonie Scholz, Christian-H Heeger, Andreas Rillig, Bruno Reissmann, Christine Lemeš, Tilmann Maurer, Thomas Fink, Osamu Inaba, Naotaka Hashiguchi, Karl-Heinz Kuck, Feifan Ouyang & Shibu Mathew

  2. Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy

    Francesco Santoro & Natale Daniele Brunetti

  3. University Heart Center Lübeck, Lübeck, Germany

    Christian-H Heeger

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  1. Francesco Santoro
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  2. Andreas Metzner
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Correspondence to Francesco Santoro.

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Santoro, F., Metzner, A., Scholz, L. et al. Prognostic significance of ventricular tachycardia clustering after catheter ablation in non-ischemic dilated cardiomyopathy. Clin Res Cardiol 108, 539–548 (2019). https://doi.org/10.1007/s00392-018-1384-2

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  • DOI: https://doi.org/10.1007/s00392-018-1384-2

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