Pleomorphic ventricular tachycardia in dilated cardiomyopathy is a strong predictor of VT recurrence after ablation independent of cardiac function: Comparison with ischemic cardiomyopathy

• Published in: Europace (London, England) England), 2021-05, Vol.23 (Supplement_3)
• Main Authors: Kimura, Y, De Riva, M, Ebert, M, Glashan, C, Piers, SRD, Trines, SA, Wijnmaalen, AP, Zeppenfeld, K
• Format: Article
• Language: English
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/euab116.355

Abstract Funding Acknowledgements Type of funding sources: None. Background   Compared to ICM patients, subgroups of DCM patients show higher VT recurrence rates after catheter ablation (CA), despite similar percentages of acute non-inducibility. Pleomorphic VTs (PL-VT) have been reported in ICM patients with fibrotic remodeling and progressive heart failure.  Diffuse fibrosis is the dominant scar pattern in DCM. In these patients PL-VT may occur independent of cardiac function.  Aim   To investigate the prevalence, relation with cardiac function, and impact of PL-VT on long-term ablation outcome in patients with ICM and DCM.  Methods   Consecutive patients with ICM or DCM undergoing VT ablation (ICM 2009-2016; DCM 2008-2018) were included. PL-VT was defined as ≥1 spontaneous change of the 12-lead VT morphology lasting for ≥6 consecutive beats during the same induced VT episode. Complete procedural success was defined as non-inducibility of any VT at the end of the procedure. Patients were followed for VT recurrence and mortality.  Results   A total of 247 patients (86% men, age 63 ± 13 years) underwent CA for monomorphic VT, 152 with ICM (62%), and 95 with DCM (38%). Complete procedural success was achieved in 39% in ICM vs. 37% in DCM, respectively. PL-VT was observed in 22 and 29 patients with ICM and DCM, respectively (14% vs. 31%, P = 0.003). Among ICM patients, PL-VT was associated with a lower LVEF (PL-VT+ 28 ± 9% vs. PL-VT- 34 ± 12%, P = 0.02) and only occurred if LVEF was 40%. After propensity score matching to account for baseline differences (age, gender, LVEF, prior VT ablation, VT storm, and amiodarone use), between ICM vs. DCM patients, the PLVT incidence was 4 times higher in DCM patients (7% [4/60] vs. 28% [17/60], P = 0.003).   During a median follow-up of 30 months, 79 (32%) patients died (ICM 48 [32%), DCM 31 [33%], P = 0.88) and 120 (49%) patients had VT recurrence (ICM 59 [39%], DCM 61 [64%], P