title: Scar Homogenization Versus Limited-Substrate Ablation in Patients With Nonischemic Cardiomyopathy and Ventricular Tachycardia.
abstract: Scar homogenization improves long-term ventricular arrhythmia-free survival compared with standard limited-substrate ablation in patients with post-infarction ventricular tachycardia (VT). Whether such benefit extends to patients with nonischemic cardiomyopathy and scar-related VT is unclear.
  
  
  
  The aim of this study was to assess the long-term efficacy of an endoepicardial scar homogenization approach compared with standard ablation in this population.
  
  
  
  Consecutive patients with dilated nonischemic cardiomyopathy (n = 93), scar-related VTs, and evidence of low-voltage regions on the basis of pre-defined criteria on electroanatomic mapping (i.e., bipolar voltage <1.5 mV) underwent either standard VT ablation (group 1 [n = 57]) or endoepicardial ablation of all abnormal potentials within the electroanatomic scar (group 2 [n = 36]). Acute procedural success was defined as noninducibility of any VT at the end of the procedure; long-term success was defined as freedom from any ventricular arrhythmia at follow-up.
  
  
  
  Acute procedural success rates were 69.4% and 42.1% after scar homogenization and standard ablation, respectively (p = 0.01). During a mean follow-up period of 14 ± 2 months, single-procedure success rates were 63.9% after scar homogenization and 38.6% after standard ablation (p = 0.031). After multivariate analysis, scar homogenization and left ventricular ejection fraction were predictors of long-term success. During follow-up, the rehospitalization rate was significantly lower in the scar homogenization group (p = 0.035).
  
  
  
  In patients with dilated nonischemic cardiomyopathy, scar-related VT, and evidence of low-voltage regions on electroanatomic mapping, endoepicardial homogenization of the scar significantly increased freedom from any recurrent ventricular arrhythmia compared with a standard limited-substrate ablation. However, the success rate with this approach appeared to be lower than previously reported with ischemic cardiomyopathy, presumably because of the septal and midmyocardial distribution of the scar in some patients.
authors: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Department of Cardiology, Gülhane Military Academy of Medicine, Ankara, Turkey.
authors: Yalçın
authors: Y
authors: Gökoğlan
authors: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Dell Medical School, University of Texas, Austin, Texas.
authors: Sanghamitra
authors: S
authors: Mohanty
authors: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors: Carola
authors: C
authors: Gianni
authors: Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Pasquale
authors: P
authors: Santangeli
authors: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
authors: Chintan
authors: C
authors: Trivedi
authors: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Department of Cardiology, Turgut Ozal University Faculty of Medicine, Alparslan, Turkey.
authors: Mahmut F
authors: MF
authors: Güneş
authors: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors: Rong
authors: R
authors: Bai
authors: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
authors: Amin
authors: A
authors: Al-Ahmad
authors: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
authors: G Joseph
authors: GJ
authors: Gallinghouse
authors: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
authors: Rodney
authors: R
authors: Horton
authors: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
authors: Patrick M
authors: PM
authors: Hranitzky
authors: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
authors: Javier E
authors: JE
authors: Sanchez
authors: Electrophysiology and Arrhythmia Services, California Pacific Medical Center, San Francisco, California.
authors: Salwa
authors: S
authors: Beheiry
authors: Electrophysiology and Arrhythmia Services, California Pacific Medical Center, San Francisco, California.
authors: Richard
authors: R
authors: Hongo
authors: University of Kansas Hospital, Kansas City, Kansas.
authors: Dhanunjaya
authors: D
authors: Lakkireddy
authors: University of Kansas Hospital, Kansas City, Kansas.
authors: Madhu
authors: M
authors: Reddy
authors: Akron General Hospital, Akron, Ohio.
authors: Robert A
authors: RA
authors: Schweikert
authors: RCCS Monzino Hospital, Milan, Italy.
authors: Antonio
authors: A
authors: Dello Russo
authors: RCCS Monzino Hospital, Milan, Italy.
authors: Michela
authors: M
authors: Casella
authors: RCCS Monzino Hospital, Milan, Italy.
authors: Claudio
authors: C
authors: Tondo
authors: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
authors: J David
authors: JD
authors: Burkhardt
authors: Ospedale dell'Angelo, Mestre/Venice, Italy.
authors: Sakis
authors: S
authors: Themistoclakis
authors: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors: Luigi
authors: L
authors: Di Biase
authors: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Dell Medical School, University of Texas, Austin, Texas; Electrophysiology and Arrhythmia Services, California Pacific Medical Center, San Francisco, California; Interventional Electrophysiology, Scripps Clinic, La Jolla, California; Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Cardiology, Stanford University, Stanford, California. Electronic address: dr.natale@gmail.com.
authors: Andrea
authors: A
authors: Natale
mesh_terms: D002311:Cardiomyopathy, Dilated / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D002318:Cardiovascular Diseases; D017115:Catheter Ablation; D002921:Cicatrix / Q000150:complications / Q000209:etiology / Q000601:surgery*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D011446:Prospective Studies; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*
keywords: electroanatomic mapping; inducibility; low-voltage areas; ventricular arrhythmia