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Outcomes Associated With Catheter Ablation of Ventricular Tachycardia in Patients With Cardiac Sarcoidosis
JAMA Cardiology  (IF14.676),  Pub Date : 2021-11-17, DOI: 10.1001/jamacardio.2021.4738
Konstantinos C. Siontis, Pasquale Santangeli, Daniele Muser, Francis E. Marchlinski, Katja Zeppenfeld, Jarieke C. Hoogendoorn, Calambur Narasimhan, William H. Sauer, Matthew M. Zipse, Suraj Kapa, Vasanth Vedantham, David G. Rosenthal, Melissa R. Robinson, Kristen K. Patton, Francis Murgatroyd, Alexandru B. Chicos, Kyoko Soejima, Henri Roukoz, Frederic Sacher, Adarsh Bhan, Jason Appelbaum, Timm Dickfeld, Pranav Mankad, Kenneth A. Ellenbogen, Jordana Kron, Hyungjin Myra Kim, James Froehlich, Kim A. Eagle, Frank M. Bogun, Thomas C. Crawford

Importance Ventricular tachycardia (VT) is associated with high mortality in patients with cardiac sarcoidosis (CS), and medical management of CS-associated VT is limited by high failure rates. The role of catheter ablation has been investigated in small, single-center studies.

Objective To investigate outcomes associated with VT ablation in patients with CS.

Design, Setting, and Participants This cohort study from the Cardiac Sarcoidosis Consortium registry (2003-2019) included 16 tertiary referral centers in the US, Europe, and Asia. A total of 158 consecutive patients with CS and VT were included (33% female; mean [SD] age, 52 [11] years; 53% with ejection fraction [EF] <50%).

Exposures Catheter ablation of CS-associated VT and, as appropriate, medical treatment.

Main Outcomes and Measures Immediate and short-term outcomes included procedural success, elimination of VT storm, and reduction in defibrillator shocks. The primary long-term outcome was the composite of VT recurrence, heart transplant (HT), or death.

Results Complete procedural success (no inducible VT postablation) was achieved in 85 patients (54%). Sixty-five patients (41%) had preablation VT storm that did not recur postablation in 53 (82%). Defibrillator shocks were significantly reduced from a median (IQR) of 2 (1-5) to 0 (0-0) in the 30 days before and after ablation (P < .001). During median (IQR) follow-up of 2.5 (1.1-4.9) years, 73 patients (46%) experienced VT recurrence and 81 (51%) experienced the composite primary outcome. One- and 2-year rates of survival free of VT recurrence, HT, or death were 60% and 52%, respectively. EF less than 50% and myocardial inflammation on preprocedural 18F-fluorodeoxyglucose positron emission tomography were significantly associated with adverse prognosis in multivariable analysis for the primary outcome (HR, 2.24; 95% CI, 1.37-3.64; P = .001 and HR, 2.93; 95% CI, 1.31-6.55; P = .009, respectively). History of hypertension was associated with a favorable long-term outcome (adjusted HR, 0.51; 95% CI, 0.28-0.92; P = .02).

Conclusions and Relevance In this observational study of selected patients with CS and VT, catheter ablation was associated with reductions in defibrillator shocks and recurrent VT storm. Preablation LV dysfunction and myocardial inflammation were associated with adverse long-term prognosis. These data support the role of catheter ablation in conjunction with medical therapy in the management of CS-associated VT.