. 2022 Sep 13;80(11):1045-1056.

doi: 10.1016/j.jacc.2022.06.035.

Clinical Outcomes in Patients With Dilated Cardiomyopathy and Ventricular Tachycardia

Katja Zeppenfeld¹, Adrianus P Wijnmaalen², Micaela Ebert³, Samuel H Baldinger⁴, Antonio Berruezo⁵, Valentina Catto⁶, Marmar Vaseghi⁷, Arash Arya⁸, Saurabh Kumar⁹, Marta de Riva¹⁰, Thomas Deneke¹¹, Thomas Gaspar¹², Kyoko Soejima¹³, Nienke van Rein¹⁴, Usha B Tedrow¹⁵, Chistopher Piorkowski¹², Kalyanam Shivkumar¹⁶, Corrado Carbucicchio⁶, Gerhard Hindricks¹⁷, William G Stevenson¹⁸

Affiliations

¹ Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: k.zeppenfeld@lumc.nl.
² Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: https://twitter.com/HWijnmaalen.
³ Heart Center Leipzig at University of Leipzig, Leipzig, Germany. Electronic address: https://twitter.com/micaela_ebert.
⁴ Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
⁵ Cardiovascular Institute Hospital Clinic and Heart Institute, Teknon Medical Center, Spain Cardiovascular Institute Hospital Clinic, Barcelona, Spain. Electronic address: https://twitter.com/DrBerruezo.
⁶ Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
⁷ UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
⁸ Heart Center Leipzig at University of Leipzig, Leipzig, Germany. Electronic address: https://twitter.com/ArashArya_EP.
⁹ Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
¹⁰ Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: https://twitter.com/martaderiva.
¹¹ Heartcenter Bad Neustadt, Bad Neustadt, Germany. Electronic address: https://twitter.com/EPDeneke.
¹² Herzzentrum Dresden, Dresden, Germany.
¹³ Kyorin University, Tokyo, Japan.
¹⁴ Departments of Epidemiology and Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands.
¹⁵ Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA. Electronic address: https://twitter.com/utedrow.
¹⁶ UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA. Electronic address: https://twitter.com/shivkumarmd.
¹⁷ Heart Center Leipzig at University of Leipzig, Leipzig, Germany. Electronic address: https://twitter.com/gerdhindricks.
¹⁸ Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA. Electronic address: https://twitter.com/wgstevenson1.

PMID: 36075673
DOI: 10.1016/j.jacc.2022.06.035

Free article

Clinical Outcomes in Patients With Dilated Cardiomyopathy and Ventricular Tachycardia

Katja Zeppenfeld et al. J Am Coll Cardiol. 2022.

Free article

. 2022 Sep 13;80(11):1045-1056.

doi: 10.1016/j.jacc.2022.06.035.

Authors

Affiliations

¹ Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: k.zeppenfeld@lumc.nl.
² Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: https://twitter.com/HWijnmaalen.
³ Heart Center Leipzig at University of Leipzig, Leipzig, Germany. Electronic address: https://twitter.com/micaela_ebert.
⁴ Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
⁵ Cardiovascular Institute Hospital Clinic and Heart Institute, Teknon Medical Center, Spain Cardiovascular Institute Hospital Clinic, Barcelona, Spain. Electronic address: https://twitter.com/DrBerruezo.
⁶ Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
⁷ UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
⁸ Heart Center Leipzig at University of Leipzig, Leipzig, Germany. Electronic address: https://twitter.com/ArashArya_EP.
⁹ Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
¹⁰ Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: https://twitter.com/martaderiva.
¹¹ Heartcenter Bad Neustadt, Bad Neustadt, Germany. Electronic address: https://twitter.com/EPDeneke.
¹² Herzzentrum Dresden, Dresden, Germany.
¹³ Kyorin University, Tokyo, Japan.
¹⁴ Departments of Epidemiology and Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands.
¹⁵ Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA. Electronic address: https://twitter.com/utedrow.
¹⁶ UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA. Electronic address: https://twitter.com/shivkumarmd.
¹⁷ Heart Center Leipzig at University of Leipzig, Leipzig, Germany. Electronic address: https://twitter.com/gerdhindricks.
¹⁸ Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA. Electronic address: https://twitter.com/wgstevenson1.

PMID: 36075673
DOI: 10.1016/j.jacc.2022.06.035

Abstract

Background: Recurrent ventricular tachycardia (VT) due to dilated cardiomyopathy (DCM) is difficult to treat, and long-term outcome data are limited.

Objectives: The aim of this study was to identify predictors of mortality or heart transplantation (HTx) and VT recurrence.

Methods: Consecutive patients with DCM accepted for radiofrequency catheter ablation (RFCA) of VT at 9 centers were prospectively enrolled and followed.

Results: Of 281 consecutive patients (mean age 60 ± 13 years, 85% men, mean left ventricular ejection fraction [LVEF] 36% ± 12%), 35% had VT storm, 20% had incessant VT, and amiodarone was unsuccessful in 68%. During follow-up of 21 months (IQR: 6-30 months), 67 patients (24%) died or underwent HTx, and 138 (49%) had VT recurrence (45 within 30 days, defined as early); the 4-year rate of VT recurrence or mortality or HTx was 70%. Independent predictors of mortality or HTx were early VT recurrence (HR: 2.92; 95% CI: 1.37-6.21; P < 0.01), amiodarone at discharge (HR: 3.23; 95% CI: 1.43-7.33; P < 0.01), renal dysfunction (HR: 1.92; 95% CI: 1.01-3.64; P = 0.046), and LVEF (HR: 1.36; 95% CI: 1.0-1.84; P = 0.052). LVEF ≤32% identified patients at risk for mortality or HTx (area under the curve: 0.75). Mortality or HTx per 100 person-years was 40.4 events after early, compared with 14.2 events after later VT recurrence and 8.5 events with no VT recurrence after RFCA (P < 0.01 for both). Patients with early recurrence and LVEFs ≤32% had a 1-year rate of mortality or HTx of 55%. VT recurrence was predicted by prior implantable cardioverter-defibrillator shocks, basal anteroseptal VT origin, and procedural failure but not LVEF.

Conclusions: Patients with DCM needing RFCA for VT are a high-risk group. Following RFCA, approximately one-half remain free of VT recurrence. Early VT recurrence with LVEF ≤32% identifies those at very high risk for mortality or HTx, and screening for mechanical support or HTx should be considered. Late VT recurrence after RFCA does not predict worse outcome.

Keywords: VT recurrence; mortality; nonischemic cardiomyopathy; radiofrequency catheter ablation.

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Conflict of interest statement

Funding Support and Author Disclosures This study was partially supported by an investigator-initiated grant (IIS-310) from Biosense Webster (a Johnson & Johnson company). Dr Zeppenfeld has received research grants from Biosense Webster to the Department of Cardiology at Leiden University Medical Center. Dr Wijnmaalen has received research grants from Biosense Webster to the Department of Cardiology at Leiden University Medical Center. Dr Berruezo is a stockholder in ADAS3D; and has received research grants from Biosense Webster and Biotronik. Dr Vaseghi is an educational consultant for Biosense Webster; and holds founder shares in NeuCures. Dr de Riva has received research grants from Biosense Webster to the Department of Cardiology at Leiden University Medical Center. Dr Piorkowski is chief medical officer of Abbott EP. Dr Stevenson has received speaker honoraria from Abbott, Boston Scientific, Biotronik, Johnson & Johnson, and Medtronic; and has received a research grant from Thermedical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Comment in

Insights From the Dilated Cardiomyopathy Ventricular Tachycardia Ablation Study: Wisdom Through Humility.
Tzou WS. Tzou WS. J Am Coll Cardiol. 2022 Sep 13;80(11):1057-1059. doi: 10.1016/j.jacc.2022.06.033. J Am Coll Cardiol. 2022. PMID: 36075674 No abstract available.

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Clinical Outcomes in Patients With Dilated Cardiomyopathy and Ventricular Tachycardia

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Clinical Outcomes in Patients With Dilated Cardiomyopathy and Ventricular Tachycardia

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