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Abstract：
This study sought to characterize ventricular tachycardia (VT) ablation outcomes across nonischemic cardiomyopathy (NICM) etiologies and adjust these outcomes by patient-related comorbidities that could explain differences in arrhythmia recurrence rates.
Outcomes of catheter ablation of VT in patients with NICM could be related to etiology of NICM.
Data from 2,075 patients with structural heart disease referred for catheter ablation of VT from 12 international centers was retrospectively analyzed. Patient characteristics and outcomes were noted for the 6 most common NICM etiologies. Multivariable Cox proportional hazards modeling was used to adjust for potential confounders.
Of 780 NICM patients (57 ± 14 years of age, 18% women, left ventricular ejection fraction 37 ± 13%), underlying prevalence was 66% for dilated idiopathic cardiomyopathy (DICM), 13% for arrhythmogenic right ventricular cardiomyopathy (ARVC), 6% for valvular cardiomyopathy, 6% for myocarditis, 4% for hypertrophic cardiomyopathy, and 3% for sarcoidosis. One-year freedom from VT was 69%, and freedom from VT, heart transplantation, and death was 62%. On unadjusted competing risk analysis, VT ablation in ARVC demonstrated superior VT-free survival (82%) versus DICM (p ≤ 0.01). Valvular cardiomyopathy had the poorest unadjusted VT-free survival, at 47% (p < 0.01). After adjusting for comorbidities, including age, heart failure severity, ejection fraction, prior ablation, and antiarrhythmic medication use, myocarditis, ARVC, and DICM demonstrated similar outcomes, whereas hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis had the highest risk of VT recurrence.
Catheter ablation of VT in NICM is effective. Etiology of NICM is a significant predictor of outcomes, with ARVC, myocarditis, and DICM having similar but superior outcomes to hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis, after adjusting for potential covariates.
Outcomes of catheter ablation of VT in patients with NICM could be related to etiology of NICM.
Data from 2,075 patients with structural heart disease referred for catheter ablation of VT from 12 international centers was retrospectively analyzed. Patient characteristics and outcomes were noted for the 6 most common NICM etiologies. Multivariable Cox proportional hazards modeling was used to adjust for potential confounders.
Of 780 NICM patients (57 ± 14 years of age, 18% women, left ventricular ejection fraction 37 ± 13%), underlying prevalence was 66% for dilated idiopathic cardiomyopathy (DICM), 13% for arrhythmogenic right ventricular cardiomyopathy (ARVC), 6% for valvular cardiomyopathy, 6% for myocarditis, 4% for hypertrophic cardiomyopathy, and 3% for sarcoidosis. One-year freedom from VT was 69%, and freedom from VT, heart transplantation, and death was 62%. On unadjusted competing risk analysis, VT ablation in ARVC demonstrated superior VT-free survival (82%) versus DICM (p ≤ 0.01). Valvular cardiomyopathy had the poorest unadjusted VT-free survival, at 47% (p < 0.01). After adjusting for comorbidities, including age, heart failure severity, ejection fraction, prior ablation, and antiarrhythmic medication use, myocarditis, ARVC, and DICM demonstrated similar outcomes, whereas hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis had the highest risk of VT recurrence.
Catheter ablation of VT in NICM is effective. Etiology of NICM is a significant predictor of outcomes, with ARVC, myocarditis, and DICM having similar but superior outcomes to hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis, after adjusting for potential covariates.
摘要：
这项研究旨在描述非缺血性心肌病（NICM）病因的室性心动过速（VT）消融结果，并通过与患者相关的合并症来调整这些结果，以解释心律失常复发率的差异。
NICM患者经导管消融术治疗室性心动过速的结果可能与NICM的病因有关。
回顾性分析来自12个国际中心的2,075例结构性心脏病患者接受室性心动过速导管消融术的数据。记录了6种最常见的NICM病因的患者特征和结果。多变量Cox比例风险模型用于调整潜在的混杂因素。
在780名NICM患者中（57±14岁，18%的女性,左心室射血分数37±13%），扩张型特发性心肌病（DICM）的潜在患病率为66％，13％的致心律失常性右心室心肌病（ARVC），6%为瓣膜性心肌病，6％为心肌炎，4%为肥厚型心肌病，结节病占3%。一年的VT自由度为69％，和脱离VT的自由，心脏移植,死亡人数为62%。关于未经调整的竞争风险分析，与DICM相比，ARVC中的VT消融显示出较高的无VT生存率（82％）（p≤0.01）。瓣膜性心肌病的未调整无VT生存率最差，47%(p<0.01)。调整合并症后，包括年龄,心力衰竭严重程度,射血分数,先前消融，和抗心律失常药物的使用，心肌炎,ARVC,和DICM表现出类似的结果，而肥厚型心肌病，瓣膜性心肌病,结节病的VT复发风险最高。
NICM中室性心动过速的导管消融术是有效的。NICM的病因是结果的重要预测因子，ARVC,心肌炎,DICM与肥厚型心肌病具有相似但优越的结局，瓣膜性心肌病,结节病，在调整潜在协变量后。
NICM患者经导管消融术治疗室性心动过速的结果可能与NICM的病因有关。
回顾性分析来自12个国际中心的2,075例结构性心脏病患者接受室性心动过速导管消融术的数据。记录了6种最常见的NICM病因的患者特征和结果。多变量Cox比例风险模型用于调整潜在的混杂因素。
在780名NICM患者中（57±14岁，18%的女性,左心室射血分数37±13%），扩张型特发性心肌病（DICM）的潜在患病率为66％，13％的致心律失常性右心室心肌病（ARVC），6%为瓣膜性心肌病，6％为心肌炎，4%为肥厚型心肌病，结节病占3%。一年的VT自由度为69％，和脱离VT的自由，心脏移植,死亡人数为62%。关于未经调整的竞争风险分析，与DICM相比，ARVC中的VT消融显示出较高的无VT生存率（82％）（p≤0.01）。瓣膜性心肌病的未调整无VT生存率最差，47%(p<0.01)。调整合并症后，包括年龄,心力衰竭严重程度,射血分数,先前消融，和抗心律失常药物的使用，心肌炎,ARVC,和DICM表现出类似的结果，而肥厚型心肌病，瓣膜性心肌病,结节病的VT复发风险最高。
NICM中室性心动过速的导管消融术是有效的。NICM的病因是结果的重要预测因子，ARVC,心肌炎,DICM与肥厚型心肌病具有相似但优越的结局，瓣膜性心肌病,结节病，在调整潜在协变量后。
