Long-term outcome after multiple VT ablations in NICM patients

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BACKGROUND: Data about ventricular tachycardia (VT) ablation in patients with non-ischemic cardiomyopathies (NICM) is limited. This study sought to compare the acute and long-term outcomes of VT ablation in different NICMs. METHODS: In this large single-center study consecutive patients presenting with NICM and sustained VTs undergoing VT ablation were included from May 2016 to February 2022. The patients were divided according to underlying NICM and investigated regarding endpoints of VT recurrences and cardiovascular mortality. RESULTS: A total of 206 patients undergoing a total of 323 VT ablations were included (59 ± 16 years; 81% male; LVEF 36 ± 14%; DCM 57%, myocarditis 26%, sarcoidosis 8%, ARVC 9%). The acute procedural success was highest among ARVC (90%) and lowest among DCM patients (74%). 17% showed in-hospital recurrences (4% clinical VTs) with no difference among different NICMs. DCM patients were discharged with highest rates of antiarrhythmic drugs (41%), whereas ARVC patients with lowest (11%). Long-term VT recurrences during mean follow-up of 38 ± 22 months were highest among DCM patients with 61% followed by myocarditis with 56%, ARVC with 41% and sarcoidosis with 35% (log-rank p = 0.148). The recurrences of clinical VT were present in only 5% of all patients. 52 patients with recurrences (51%) underwent a second procedure with recurrences rates of any VT in 50% (highest among DCM patients; log-rank p = 0.259). 20 patients underwent a 3rd VT ablation, 15 a 4th, 6 a 5th and 1 patient a 6th procedure. Freedom from any VT after multiple procedures were different among etiologies (57% DCM vs. 74% myocarditis vs. 71% sarcoidosis vs. 82% ARVC; log-rank p = 0.067). Cardiovascular mortality was 19% with highest rates among DCM patients (log-rank p = 0.001). CONCLUSIONS: VT ablation among patients with NICM is highly effective with sufficient rhythm control in 2/3 of all patients, but non-clinical VT recurrences are common, especially in DCM patients. Those patients reveal highest cardiovascular mortality.

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