title: Catheter ablation of ventricular tachycardia and mortality in patients with nonischemic dilated cardiomyopathy: can noninducibility after ablation be a predictor for reduced mortality?
abstract: BACKGROUND
  Data on outcomes after catheter ablation of ventricular tachycardia (VT) in patients with nonischemic dilated cardiomyopathy (NIDCM) are insufficient. We aimed to investigate the effects of successful catheter ablation of VT on cardiac mortality in patients with NIDCM.
  
  
  RESULTS
  One hundred two patients with NIDCM (86 men; mean age, 58.8±15.2 years; mean ejection fraction, 33.3±11.9%) underwent VT ablation. After catheter ablation, a programmed ventricular stimulation to test for success was performed. Complete VT noninducibility was achieved in 62 (61%) patients and partial success or failure in 32 (31%) patients. During 2 years of follow-up, VT recurrence was observed in 33 patients (53%) without inducible VTs and in 24 patients (75%) with inducible VT inducible (P=0.041). VT inducibility was associated with higher VT recurrence (adjusted hazard ratio, 1.84; 95% confidence interval, 1.08-3.13; P=0.025). The primary end point of all-cause mortality was reached in 9 patients (15%) with noninducible VTs versus 11 patients (34%) with inducible sustained VTs (P=0.026). VT inducibility was associated with all-cause mortality (adjusted hazard ratio, 2.73; 95% confidence interval, 1.003-7.43; P=0.049).
  
  
  CONCLUSIONS
  In patients with NIDCM and recurrent sustained VTs, a complete ablation of all inducible VTs may be achieved in 60% of the cases. The complete noninducibility may be a preferable end point of ablation because it was associated with better long-term success. Importantly, if possible to achieve through ablation, a complete VT noninducibility was associated with reduction of the likelihood for all-cause mortality in patients with NIDCM.
authors: From the Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany. dinov@gmx.de.
authors: Borislav
authors: B
authors: Dinov
authors: From the Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors: Arash
authors: A
authors: Arya
authors: From the Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors: Alexandra
authors: A
authors: Schratter
authors: From the Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors: Valentina
authors: V
authors: Schirripa
authors: From the Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors: Lukas
authors: L
authors: Fiedler
authors: From the Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors: Philipp
authors: P
authors: Sommer
authors: From the Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors: Andreas
authors: A
authors: Bollmann
authors: From the Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors: Sascha
authors: S
authors: Rolf
authors: From the Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors: Christopher
authors: C
authors: Piorkowski
authors: From the Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors: Gerhard
authors: G
authors: Hindricks
mesh_terms: D000328:Adult; D000368:Aged; D002304:Cardiac Pacing, Artificial; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D018572:Disease-Free Survival; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005858:Germany; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: cardiomyopathy, dilated; catheter ablation; mortality; tachycardia, ventricular