56-31: High mortality after Ablation of Ventricular Tachycardia in patients with Dilated Cardiomyopathy

Abstract

Background: In patients with dilated cardiomyopathy, ventricular tachycardia (VT) causes significant morbidity and mortality. Implantable cardioverter defibrillator (ICD) shocks terminate VT but confer a significant morbidity and mortality risk. Therefore, VT ablation is increasingly common. Outcome data following ablation is sparse. We present long-term outcome data following ablation for VT in patients with DCM. Methods: Long-term follow up was performed in all patients ( pts) with DCM undergoing VT ablation at our institution between 2004 and 2013. Results: VT ablation was performed in 96 pts with DCM who underwent VT ablation at our institution and follow-up (F/U) data were analysed in 94 pts. Two pts were lost to F/U. Mean age was 58 + 13 years, 76/94 pts (81%) were male, mean left ventricular ejection fraction was 32 + 11 and 62/94 pts (65,9%) had an ICD implanted prior to the ablation procedure. In 21/ 96 (21,8%) pts a frustrane VT Ablation was performed at different institutions previously to our index procedure. Comorbidities in this patient population included hypertension in 48/94 (51%), diabetes in 13/94 (13,8%) and renal insufficiency in 31/94 pts (32,9%). Eight pts (8,5%) were in VT storm at time of presentation. Ablation strategy included solely endocardial ablation in 66/96 patients (68,8%), an epicardial ablation approach was performed in the remaining 30/96 (31,2%) pts. Out of these a solely epicardial approach was necessary in 14/96 patients (14,5%) and a combined endo-and epicardial ablation in 16/96 patients (16,7%). Mean F/U time was 4,2 + 3,4 years. Recurrent VT were seen in 50/94 pts (52,3%) and 27/94 pts (28,7%) had repeat ablations. During a mean F/U of 1080 + 984 days 31/94 patients (33%) died. Mean LVF was 32 + 10 (LVF , 35%: 26/31(83,9%) pts), in 3/31 (9,7%) pts a Left Ventricular Assist Device (LVAD) was implanted and 5/31 (16,1%) pts were listed for heart transplantation after index procedure during F/U. Recurrence of VT was observed in 18/31 pts (58%). Conclusions: In patients with DCM and VT, mortality and VT recurrence rates after catheter ablation are high. Therefore, in these patients high quality care is mandatory.