title: Long-Term Outcome After Catheter Ablation of Ventricular Tachycardia in Patients With Nonischemic Dilated Cardiomyopathy.
abstract: BACKGROUND
  Catheter ablation (CA) of ventricular tachycardia (VT) in patients with nonischemic dilated cardiomyopathy can be challenging because of the complexity of underlying substrates. We sought to determine the long-term outcomes of endocardial and adjuvant epicardial CA in nonischemic dilated cardiomyopathy.
  
  
  RESULTS
  We examined 282 consecutive patients (aged 59±15 years, 80% males) with nonischemic dilated cardiomyopathy who underwent CA. Ablation was guided by activation/entrainment mapping for tolerated VT and pacemapping/targeting of abnormal electrograms for unmappable VT. Adjuvant epicardial ablation was performed for recurrent VT or persistent inducibility after endocardial-only ablation. Epicardial ablation was performed in 90 (32%) patients. Before ablation, patients failed a median of 2 antiarrhythmic drugs), including amiodarone, in 166 (59%) patients. The median follow-up after the last procedure was 48 (19-67) months. Overall, VT-free survival was 69% at 60-month follow-up. Transplant-free survival was 76% and 68% at 60- and 120-month follow-up, respectively. Among the 58 (21%) patients with VT recurrence, CA still resulted in a significant reduction of VT burden, with 31 (53%) patients having only isolated (1-3) VT episodes in 12 (4-35) months after the procedure. At the last follow-up, 128 (45%) patients were only on β-blockers or no treatment, 41 (15%) were on sotalol or class I antiarrhythmic drugs, and 62 (22%) were on amiodarone.
  
  
  CONCLUSIONS
  In patients with nonischemic dilated cardiomyopathy and VT, endocardial and adjuvant epicardial CA is effective in achieving long-term VT freedom in 69% of cases, with a substantial improvement in VT burden in many of the remaining patients.
authors.affiliation: From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Daniele
authors.initials: D
authors.lastname: Muser
authors.affiliation: From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.affiliation: From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Simon A
authors.initials: SA
authors.lastname: Castro
authors.affiliation: From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Rajeev K
authors.initials: RK
authors.lastname: Pathak
authors.affiliation: From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Jackson J
authors.initials: JJ
authors.lastname: Liang
authors.affiliation: From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Hayashi
authors.affiliation: From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Silvia
authors.initials: S
authors.lastname: Magnani
authors.affiliation: From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Fermin C
authors.initials: FC
authors.lastname: Garcia
authors.affiliation: From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Mathew D
authors.initials: MD
authors.lastname: Hutchinson
authors.affiliation: From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Supple
authors.affiliation: From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: David S
authors.initials: DS
authors.lastname: Frankel
authors.affiliation: From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Riley
authors.affiliation: From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: David
authors.initials: D
authors.lastname: Lin
authors.affiliation: From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Schaller
authors.affiliation: From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dixit
authors.affiliation: From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Erica S
authors.initials: ES
authors.lastname: Zado
authors.affiliation: From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: David J
authors.initials: DJ
authors.lastname: Callans
authors.affiliation: From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia. francis.marchlinski@uphs.upenn.edu.
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D002311:Cardiomyopathy, Dilated / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: antiarrhythmic drug; catheter ablation; dilated cardiomyopathy; electroanatomic mapping; ventricular tachycardia