Catheter ablation (CA) is effective in the treatment of ventricular tachycardia (VT). Although some observational data suggest patients with non-ischemic cardiomyopathy (NICM) have less favorable ...outcomes when compared to those with an ischemic etiology (ICM), direct comparisons are rarely reported. We aimed to compare the outcomes of VT ablation in a propensity-score matched population of ICM or NICM patients.
Single-center retrospective study of consecutive patients undergoing VT ablation from 2012 to 2023. A propensity score (PS) was used to match ICM and NICM patients in a 1:1 fashion according to age, sex, left ventricular ejection fraction (LVEF), NYHA class, electrical storm (ES) at presentation, and previous endocardial ablation. The outcomes of interest were VT-free survival and all-cause mortality.
The PS yielded two groups of 71 patients each (mean age 63±10 years, 92% male, mean LVEF 35±10%, 36% with ES at presentation, and 23% with previous ablation), well matched for baseline characteristics. During a median follow-up of 2.3 (interquartile range IQR 1.3–3.8) years, patients with NICM had a significantly lower VT-free survival (53.5% vs. 69.0%, log-rank p=0.037), although there were no differences regarding all-cause mortality (22.5% vs. 16.9%, log-rank p=0.245). Multivariate analysis identified NICM (HR 2.34 95% CI 1.32–4.14, p=0.004), NYHA class III/IV (HR 2.11 95% CI 1.11–4.04, p=0.024), and chronic kidney disease (HR 2.23 95% CI 1.25–3.96, p=0.006), as independent predictors of VT recurrence.
Non-ischemic cardiomyopathy patients were at increased risk of VT recurrence after ablation, although long-term mortality did not differ.
A ablação por cateter (CA) é eficaz no tratamento da taquicardia ventricular (TV). Embora dados observacionais sugiram que doentes com miocardiopatia não isquémica (NICM) apresentem piores resultados do que aqueles com etiologia isquémica (ICM), comparações diretas são escassamente reportadas. O objetivo foi comparar os resultados da ablação de TV numa população propensity-matched de doentes com NICM ou ICM.
Estudo retrospetivo unicêntrico de doentes submetidos ablação de TV, de 2012 a 2023. Usado propensity-score (PS) para emparelhar doentes com NICM e ICM numa proporção 1:1 de acordo com idade, sexo, fração de ejeção ventricular esquerda (FEVE), classe de NYHA, tempestade arrítmica à admissão e ablação endocárdica prévia. Os outcomes de interesse foram sobrevida livre de TV e morte por todas as causas.
O PS resultou em dois grupos de 71 doentes (idade 63 ± 10 anos, 93% do sexo masculino, FEVE 35 ± 10%, 36% com apresentação em tempestade arrítmica e 23% com ablação prévia). Durante um follow-up de 2,3 (1,3–3,8) anos, os doentes com NICM apresentaram menor sobrevida livre de TV (53,5% versus 69,0%, P log-rank = 0,037), apesar de não haver diferenças significativas em relação à mortalidade (22,5% versus 16,9%, P log-rank = 0,245). A análise multivariada identificou NICM (HR 2,34 IC 95% 1,32–4,14, P = 0,004), NYHA III ou IV (HR 2,11 IC 95% 1,11–4,04, P = 0,024) e doença renal crónica (HR 2,23 IC 95% 1,25–3,96, P = 0,006) como preditores independentes de recidiva de TV.
Doentes com NICM apresentam maior risco de recidiva de TV, apesar de não haver diferenças significativas na mortalidade a longo prazo.
Correspondence to Dr Rita Ataíde Silva; ritataide@gmail.com Description Few data exist on the incidence of spontaneously occurring ventricular tachycardia (VT) in the paediatric population. VT is ...often an unexpected finding in patients with otherwise normal hearts.1 2 These arrhythmias have a wide range of clinical presentation, going from infrequent ectopy to incessant VT.3 Their early diagnosis is essential to prevent ventricular dysfunction.4 The authors present a 5-year-old child without previous medical episodes, admitted to a paediatric emergency department of a secondary hospital on the grounds of gastroenteritis symptoms with 24 hours of evolution. Clinicians must be aware of the main differences between supraventricular and ventricular tachycardia, keeping high suspicion levels when adenosine does not change heart rate.
Risk stratification of Brugada syndrome (BrS) remains controversial and recommendations for an implantable cardioverter-defibrillator (ICD) are not well established. The objective of this study was ...to assess the long-term prognosis of BrS patients with an ICD.
Of 55 consecutive patients with BrS assessed between April 2002 and October 2012, 36 (mean age 41.7±13.8 years; 81.8% male) underwent ICD implantation. Nineteen (52.8%) were asymptomatic, 11 (30.6%) had previous history of syncope (arrhythmic cause suspected in eight) and six (16.7%) had aborted sudden cardiac death (SCD). Spontaneous type 1 electrocardiographic (ECG) pattern was present in 25 (69.4%) patients and electrophysiological study (EPS), performed in 26 (72.2%), was positive in 22 (84.6%). During a mean follow-up of 74±40 months (>5 years in 72% of cases), seven (19.4%) patients had appropriate shocks (annual event rate 2.8%). These patients most frequently had aborted SCD (54.1% vs. 6.9%; p=0.008) and nonsustained ventricular tachycardia (57.1% vs. 10.3%; p=0.016) during follow-up. Spontaneous type 1 ECG pattern, syncope and positive EPS were not significantly associated with appropriate shocks. Multivariate analysis revealed that aborted SCD was an independent predictor of appropriate shocks (HR 8.07, 95% CI 1.58–41.2; p=0.012). ROC curve analysis demonstrated that aborted SCD had moderate discriminatory power to predict appropriate shocks (AUC 0.751), with sensitivity of 57% and specificity of 93%. In terms of ICD-related complications, eight (22.2%) patients had inappropriate shocks during the follow-up period, mainly due to sinus tachycardia (five patients); one patient had lead infection and another had a lead fracture.
In this population of BrS patients with ICD, the long-term rate of appropriate shocks was 2.8%/year. Aborted SCD was associated with a higher risk of appropriate shocks, whereas syncope and spontaneous type I ECG pattern did not predict this event.
A estratificação de risco na síndrome de Brugada (SB) permanece controversa e as recomendações para cardiodesfibrilhador (CDI) não estão bem definidas. O objetivo deste estudo foi avaliar o prognóstico a longo prazo de doentes com SB e CDI implantado.
De 55 doentes consecutivos com SB avaliados entre abril/2002-outubro/2012, 36 (idade média 41,7±13,8 anos; 81,8% homens) implantaram CDI. Dezanove (52,8%) eram assintomáticos, 11 (30,6%) tinham história de síncope (oito com suspeita de causa arrítmica) e seis (16,7%) foram reanimados de morte súbita (MS). O eletrocardiograma (ECG) com padrão tipo 1 espontâneo estava presente em 25 (69,4%) doentes e foi realizado estudo eletrofisiológico (EEF) em 26 (72,2%), sendo positivo em 22 (84,6%). Durante o período de seguimento médio de 74±40 meses (>5 anos em 72% dos casos), sete (19,4%) doentes tiveram choques apropriados (incidência anual 2,8%). Estes doentes tinham mais frequentemente história de MS abortada (54,1 versus 6,9%; p=0,008) e taquicardia não mantida (57,1 versus 10,3%; p=0,016) durante o seguimento. Padrão ECG tipo 1 espontâneo, síncope e EEF positivo não se associaram significativamente à ocorrência de choques apropriados. Em análise multivariada a MS abortada manteve-se preditor independente de choques apropriados (HR 8,07 IC95% 1,58-41,2; p=0,012). Em análise de curvas ROC a MS abortada apresentou um poder discriminatório moderado para predizer choques apropriados (AUC 0,751) – sensibilidade 57% e especificidade 93%. Relativamente às complicações relacionadas com o CDI, oito (22,2%) doentes tiveram choques inapropriados durante o período de seguimento, sobretudo por taquicardia sinusal (cinco doentes), um infeção de elétrodo e outro fratura de elétrodo.
Na população estudada de doentes com SB e CDI implantado a incidência de choques apropriados foi 2,8%/ano. A MS abortada associou-se a um maior risco de choques apropriados, enquanto a síncope e o padrão de ECG tipo 1 espontâneo não foram preditores deste evento.
Aims
To evaluate the incidence and clinical significance of diaphragmatic myopotential (dMP) oversensing in pacemaker (PM)-dependent patients with CRT-Ds.
Methods and results
We retrospectively ...evaluated patients with CRT-Ds implanted at our institution between January 2000 and August 2006. PM-dependent patients were identified, and the incidence of inappropriate detections due to dMP oversensing and their possible clinical implications (inappropriate therapies, syncope, and death of any cause) were evaluated. CRT-Ds were implanted in 122 patients, 37 were or became PM dependent. During a mean follow-up of 22 ± 17 months, 7(18.9%) PM-dependent patients revealed inappropriate detections due to dMP oversensing. All oversensing episodes occurred in CRT-Ds with automatic gain control (AGC) sensing and integrated bipolar (IBP) leads in the RV apex. These detections led to inappropriate shocks in 2(5.4%) patients and syncope in 1(2.7%). Five (13.5%) patients died.
Conclusion
dMP oversensing in PM-dependent patients with CRT-Ds is an important problem, particularly in CRT-Ds with AGC sensing and IBP leads, with over 20% of patients with these devices revealing inappropriate detections. The clinical impact of dMP oversensing is less marked but relevant, with both inappropriate therapies and syncope occurring in this small group of 37 patients and the possibility of related deaths.
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