title: Long-term outcomes after catheter ablation of ventricular tachycardia in patients with and without structural heart disease.
abstract: Long-term outcomes after ventricular tachycardia (VT) ablation are sparsely described.
  
  
  
  The purpose of this study was to describe long-term prognosis after VT ablation in patients with no structural heart disease (no SHD), ischemic cardiomyopathy (ICM), and nonischemic cardiomyopathy (NICM).
  
  
  
  Consecutive patients (N = 695: no SHD, 98; ICM, 358; NICM, 239) ablated for sustained VT were followed for a median of 6 years. Acute procedural parameters (complete success [noninducibility of any VT]) and outcomes after multiple procedures were reported.
  
  
  
  Compared with patients with no SHD or NICM, patients with ICM were the oldest, were more likely to be men, lowest left ventricular ejection fraction, highest drug failures, VT storms, and number of inducible VTs. Complete procedure success was highest in patients with no SHD than in patients with ICM and those with NICM (79%, 56%, 60%, respectively; P < .001). At 6 years, ventricular arrhythmia (VA)-free survival was highest in patients with no SHD (77%) than in patients with ICM (54%) and those with NICM (38%) (P < .001), and overall survival was lowest in patients with ICM (48%), followed by patients with NICM (74%) and patients with no SHD (100%) (P < .001). Age, left ventricular ejection fraction, presence of SHD, acute procedural success (noninducibility of any VT), major complications, need for nonradiofrequency ablation modalities, and VA recurrence were independently associated with all-cause mortality.
  
  
  
  Long-term follow-up after VT ablation shows excellent prognosis in the absence of SHD, highest VA recurrence, and transplantation in patients with NICM and highest mortality in patients with ICM. The extremely low mortality for those without SHD suggests that VT in this population is rarely an initial presentation of a myopathic process.
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Jorge
authors.initials: J
authors.lastname: Romero
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Nishaki K
authors.initials: NK
authors.lastname: Mehta
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Akira
authors.initials: A
authors.lastname: Fujii
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Sunil
authors.initials: S
authors.lastname: Kapur
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Samuel H
authors.initials: SH
authors.lastname: Baldinger
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Barbhaiya
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Koplan
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Roy M
authors.initials: RM
authors.lastname: John
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Laurence M
authors.initials: LM
authors.lastname: Epstein
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Michaud
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Usha B
authors.initials: UB
authors.lastname: Tedrow
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: wstevenson@partners.org.
authors.forename: William G
authors.initials: WG
authors.lastname: Stevenson
mesh_terms: D000368:Aged; D009202:Cardiomyopathies / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D000069451:Long Term Adverse Effects / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D009026:Mortality; D010043:Outcome and Process Assessment, Health Care; D011379:Prognosis; D012008:Recurrence; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000628:therapy
keywords: Catheter ablation; Ischemic cardiomyopathy; Nonischemic cardiomyopathy; Structural heart disease; Ventricular tachycardia