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Substrate Characterization and Outcomes of Ventricular Tachycardia Ablation in Amyloid Cardiomyopathy: A Multicenter Study.
Compagnucci, Paolo; Dello Russo, Antonio; Gasperetti, Alessio; Schiavone, Marco; Sehrawat, Ojasav; Hasegawa, Kanae; Mohanty, Sanghamitra; Liang, Jackson J; Kapa, Suraj; La Fazia, Vincenzo Mirco; Bogun, Frank; Stevenson, William G; Tondo, Claudio; Siontis, Konstantinos C; Tandri, Harikrishna; Santangeli, Pasquale; Natale, Andrea; Casella, Michela.
Afiliación
  • Compagnucci P; Cardiology and Arrhythmology Clinic, University Hospital Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy (P.C., A.D.R., M.C.).
  • Dello Russo A; Cardiology and Arrhythmology Clinic, University Hospital Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy (P.C., A.D.R., M.C.).
  • Gasperetti A; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy. (A.D.R., A.G.).
  • Schiavone M; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy. (A.D.R., A.G.).
  • Sehrawat O; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (A.G.).
  • Hasegawa K; Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.S., C.T.).
  • Mohanty S; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (O.S., S.K., K.C.S.).
  • Liang JJ; Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (K.H., W.G.S., H.T.).
  • Kapa S; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (S.M., V.M.L.F., A.N.).
  • La Fazia VM; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (J.J.L., F.B.).
  • Bogun F; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (O.S., S.K., K.C.S.).
  • Stevenson WG; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (S.M., V.M.L.F., A.N.).
  • Tondo C; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (J.J.L., F.B.).
  • Siontis KC; Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (K.H., W.G.S., H.T.).
  • Tandri H; Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.S., C.T.).
  • Santangeli P; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Italy (C.T.).
  • Natale A; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (O.S., S.K., K.C.S.).
  • Casella M; Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (K.H., W.G.S., H.T.).
Circ Arrhythm Electrophysiol ; : e012788, 2024 Aug 22.
Article en En | MEDLINE | ID: mdl-39171384
ABSTRACT

BACKGROUND:

Sustained ventricular tachycardia (VT) in cardiac amyloidosis is uncommon, and the substrate and outcomes of catheter ablation are not defined.

METHODS:

We included 22 consecutive patients (mean age, 68±10 years; male sex, 91%) with cardiac amyloidosis (ATTR [transthyretin], n=16; light chain, n=6) undergoing catheter ablation for VT/ventricular fibrillation (VF) between 2013 and 2023 in a retrospective, observational, international study. The primary efficacy outcome was recurrent VT/VF during follow-up, while the primary safety end point included major procedure-related adverse events.

RESULTS:

The indication for ablation was drug-refractory VT in 17 patients (77%), and premature ventricular complex-initiated polymorphic VT/VF in 5 patients (23%). Catheter ablation was performed using endocardial (n=17.77%) or endo-epicardial approaches (n=5.23%). Complete endocardial electroanatomical voltage maps of the left and right ventricles were obtained in 17 (77%) and 10 (45%) patients, respectively. Each patient had evidence of low-voltage areas, most commonly involving the interventricular septum (n=16); late potentials were recorded in 16 patients (73%). A median of 1 (1-2) VT was inducible per patient; 12 of the 26 mappable VTs (46%) originated from the interventricular septum. Complete procedural success was achieved in 16 patients (73%), with 4 (18%) major procedure-related adverse events. After a median follow-up of 32 (14-42) months, sustained VT/VF recurrence was observed in 9 patients (41%); survival free from VT/VF recurrence was 56% (95% CI, 36%-86%) at 36-month follow-up, and most patients remained on antiarrhythmic drugs. A significant reduction in per patient implantable cardioverter defibrillator therapies was noted in the 6-month period after ablation (before 6 [4-9] versus after 0 [0-0]; P<0.001). In multivariable analysis, complete procedural success was associated with reduced risk of recurrent VT/VF (hazard ratio, 0.002; P=0.034).

CONCLUSIONS:

Catheter ablation can achieve control of recurrent VT/VF in more than half of patients with cardiac amyloidosis, and the reduction in VT/VF burden post-ablation may be relevant for quality of life. Septal substrate and risk of procedure-related complications challenge successful management of patients with cardiac amyloidosis and VT/VF.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Circ Arrhythm Electrophysiol Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Circ Arrhythm Electrophysiol Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos