Clinical Outcomes in Patients With Dilated Cardiomyopathy and Ventricular Tachycardia.

Zeppenfeld, Katja; Wijnmaalen, Adrianus P; Ebert, Micaela; Baldinger, Samuel H; Berruezo, Antonio; Catto, Valentina; Vaseghi, Marmar; Arya, Arash; Kumar, Saurabh; de Riva, Marta; Deneke, Thomas; Gaspar, Thomas; Soejima, Kyoko; van Rein, Nienke; Tedrow, Usha B; Piorkowski, Chistopher; Shivkumar, Kalyanam; Carbucicchio, Corrado; Hindricks, Gerhard and Stevenson, William G (2022). Clinical Outcomes in Patients With Dilated Cardiomyopathy and Ventricular Tachycardia. Journal of the American College of Cardiology, 80(11), pp. 1045-1056. Elsevier 10.1016/j.jacc.2022.06.035

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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.

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