Title

Outcomes associated with catheter ablation of ventricular tachycardia in patients with cardiac sarcoidosis

Authors

Konstantinos C. Siontis, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Pasquale Santangeli, Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia.
Daniele Muser, Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia.
Francis E. Marchlinski, Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia.
Katja Zeppenfeld, Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands.
Jarieke C. Hoogendoorn, Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands.
Calambur Narasimhan, Department of Electrophysiology, Care Hospitals, Hyderabad, India.
William H. Sauer, Section of Cardiac Electrophysiology, Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts.
Matthew M. Zipse, Section of Cardiac Electrophysiology, University of Colorado, Aurora.
Suraj Kapa, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Vasanth Vedantham, Division of Cardiology, University of California, San Francisco.
David G. Rosenthal, Division of Cardiology, University of California, San Francisco.
Melissa R. Robinson, Division of Cardiology, University of Washington, Seattle.
Kristen K. Patton, Division of Cardiology, University of Washington, Seattle.
Francis Murgatroyd, Department of Cardiology, King's College Hospital National Health Service Foundation Trust, London, United Kingdom.
Alexandru B. Chicos, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Kyoko Soejima, Department of Cardiovascular Medicine, Kyorin University Hospital, Tokyo, Japan.
Henri Roukoz, Division of Cardiology, University of Minnesota, Minneapolis.
Frederic Sacher, Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France.
Adarsh Bhan, Advocate Aurora HealthFollow
Jason Appelbaum, Division of Cardiology, University of Maryland School of Medicine, Baltimore.
Timm Dickfeld, Division of Cardiology, University of Maryland School of Medicine, Baltimore.
Pranav Mankad, Division of Cardiology, Virginia Commonwealth University, Richmond.
Kenneth A. Ellenbogen, Division of Cardiology, Virginia Commonwealth University, Richmond.
Jordana Kron, Division of Cardiology, Virginia Commonwealth University, Richmond.
Hyungjin Myra Kim, Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor.
James Froehlich, Division of Cardiovascular Medicine, Cardiovascular Center, University of Michigan, Ann Arbor.
Kim A. Eagle, Division of Cardiovascular Medicine, Cardiovascular Center, University of Michigan, Ann Arbor.
Frank M. Bogun, Division of Cardiovascular Medicine, Cardiovascular Center, University of Michigan, Ann Arbor.
Thomas C. Crawford, Division of Cardiovascular Medicine, Cardiovascular Center, University of Michigan, Ann Arbor.

Affiliations

Heart Vascular Institute, Advocate Christ Medical Center

Abstract

Importance: Ventricular tachycardia (VT) is associated with high mortality in patients with cardiac sarcoidosis (CS), and medical management of CS-associated VT is limited by high failure rates. The role of catheter ablation has been investigated in small, single-center studies. Objective: To investigate outcomes associated with VT ablation in patients with CS. Design, Setting, and Participants: This cohort study from the Cardiac Sarcoidosis Consortium registry (2003-2019) included 16 tertiary referral centers in the US, Europe, and Asia. A total of 158 consecutive patients with CS and VT were included (33% female; mean [SD] age, 52 [11] years; 53% with ejection fraction [EF] <50%). Exposures: Catheter ablation of CS-associated VT and, as appropriate, medical treatment. Main Outcomes and Measures: Immediate and short-term outcomes included procedural success, elimination of VT storm, and reduction in defibrillator shocks. The primary long-term outcome was the composite of VT recurrence, heart transplant (HT), or death. Results: Complete procedural success (no inducible VT postablation) was achieved in 85 patients (54%). Sixty-five patients (41%) had preablation VT storm that did not recur postablation in 53 (82%). Defibrillator shocks were significantly reduced from a median (IQR) of 2 (1-5) to 0 (0-0) in the 30 days before and after ablation (P < .001). During median (IQR) follow-up of 2.5 (1.1-4.9) years, 73 patients (46%) experienced VT recurrence and 81 (51%) experienced the composite primary outcome. One- and 2-year rates of survival free of VT recurrence, HT, or death were 60% and 52%, respectively. EF less than 50% and myocardial inflammation on preprocedural 18F-fluorodeoxyglucose positron emission tomography were significantly associated with adverse prognosis in multivariable analysis for the primary outcome (HR, 2.24; 95% CI, 1.37-3.64; P = .001 and HR, 2.93; 95% CI, 1.31-6.55; P = .009, respectively). History of hypertension was associated with a favorable long-term outcome (adjusted HR, 0.51; 95% CI, 0.28-0.92; P = .02). Conclusions and Relevance: In this observational study of selected patients with CS and VT, catheter ablation was associated with reductions in defibrillator shocks and recurrent VT storm. Preablation LV dysfunction and myocardial inflammation were associated with adverse long-term prognosis. These data support the role of catheter ablation in conjunction with medical therapy in the management of CS-associated VT.

Document Type

Article

PubMed ID

34787643

Link to Full Text

 

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