title: Long-term outcome of surgical cryoablation for refractory ventricular tachycardia in patients with non-ischemic cardiomyopathy.
abstract: Limited data exist on the long-term outcome of patients (pts) with non-ischemic cardiomyopathy (NICM) and ventricular tachycardia (VT) refractory to conventional therapies undergoing surgical ablation (SA). We aimed to investigate the long-term survival and VT recurrence in NICM pts with VT refractory to radiofrequency catheter ablation (RFCA) who underwent SA.
  
  
  
  Consecutive pts with NICM and VT refractory to RFCA who underwent SA were included. VT substrate was characterized in the electrophysiology lab and targeted by RFCA. During SA, previous RFCA lesions/scars were identified and targeted with cryoablation (CA; 3 min/lesion; target -150 °C). Follow-up comprised office visits, ICD interrogations and the social security death index. Twenty consecutive patients with NICM who underwent SA (age 53 ± 16 years, 18 males, LVEF 41 ± 20%; dilated CM = 9, arrhythmogenic right ventricular CM = 3, hypertrophic CM = 2, valvular CM = 4, and mixed CM = 2) were studied. Percutaneous mapping/ablation in the electrophysiology lab was performed in 18 and 2 pts had primary SA. During surgery, 4.9 ± 4.0 CA lesions/pt were delivered to the endocardium (2) and epicardium (11) or both (7). VT-free survival was 72.5% at 1 year and over 43 ± 31 months (mos) (range 1-83mos), there was only one arrhythmia-related death. There was a significant reduction in ICD shocks in the 3-mos preceding SA vs. the entire follow-up period (6.6 ± 4.9 vs. 2.3 ± 4.3 shocks/pt, P = 0.001).
  
  
  
  In select pts with NICM and VT refractory to RFCA, SA guided by pre-operative electrophysiological mapping and ablation may be a therapeutic option.
authors.affiliation: Department of Cardiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104, USA.
authors.forename: Jackson J
authors.initials: JJ
authors.lastname: Liang
authors.affiliation: Department of Cardiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104, USA.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Betensky
authors.affiliation: Department of Cardiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104, USA.
authors.forename: Daniele
authors.initials: D
authors.lastname: Muser
authors.affiliation: Department of Cardiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104, USA.
authors.forename: Erica S
authors.initials: ES
authors.lastname: Zado
authors.affiliation: Harvard-Thorndike Electrophysiology Institute, Division of Cardiovascular Disease, Beth Israel Deaconess Medical Center, Harvard Medical School, 85 Pilgrim Road, Baker 4, Boston, MA 02215, USA.
authors.forename: Elad
authors.initials: E
authors.lastname: Anter
authors.affiliation: Division of Cardiac Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: Nimesh D
authors.initials: ND
authors.lastname: Desai
authors.affiliation: Department of Cardiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Callans
authors.affiliation: Department of Cardiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104, USA.
authors.forename: Rajat
authors.initials: R
authors.lastname: Deo
authors.affiliation: Department of Cardiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Frankel
authors.affiliation: Department of Cardiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104, USA.
authors.forename: Mathew D
authors.initials: MD
authors.lastname: Hutchinson
authors.affiliation: Department of Cardiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104, USA.
authors.forename: David
authors.initials: D
authors.lastname: Lin
authors.affiliation: Department of Cardiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Riley
authors.affiliation: Department of Cardiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Schaller
authors.affiliation: Department of Cardiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104, USA.
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Supple
authors.affiliation: Department of Cardiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104, USA.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.affiliation: Division of Cardiac Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Acker
authors.affiliation: Division of Cardiac Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
authors.affiliation: Division of Cardiac Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.affiliation: Division of Cardiac Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: Prashanth
authors.initials: P
authors.lastname: Vallabhajosyula
authors.affiliation: Department of Cardiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104, USA.
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
authors.affiliation: Department of Cardiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104, USA.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dixit
mesh_terms: D000200:Action Potentials; D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D017023:Coronary Angiography; D003452:Cryosurgery / Q000009:adverse effects / Q000401:mortality; D022062:Electrophysiologic Techniques, Cardiac; D005240:Feasibility Studies; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome