PMID- 35258753 OWN - NLM STAT- MEDLINE DCOM- 20230217 LR - 20230222 IS - 1572-8595 (Electronic) IS - 1383-875X (Linking) VI - 66 IP - 1 DP - 2023 Jan TI - Outcomes of a combined vs non-combined endo-epicardial ventricular tachycardia ablation strategy. PG - 87-94 LID - 10.1007/s10840-022-01175-3 [doi] AB - BACKGROUND: Direct comparisons of combined (C-ABL) and non-combined (NC-ABL) endo-epicardial ventricular tachycardia (VT) ablation outcomes are scarce. We aimed to investigate the long-term clinical efficacy and safety of these 2 strategies in ischemic heart disease (IHD) and non-ischemic cardiomyopathy (NICM) populations. METHODS: Multicentric observational registry included 316 consecutive patients who underwent catheter ablation for drug-resistant VT between January 2008 and July 2019. Primary and secondary efficacy endpoints were defined as VT-free survival and all-cause death after ablation. Safety outcomes were defined by 30-day mortality and procedure-related complications. RESULTS: Most of the patients were male (85%), with IHD (67%) and mean age of 63 +/- 13 years. During a mean follow-up of 3 +/- 2 years, 117 (37%) patients had VT recurrence and 73 (23%) died. Multivariate survival analysis identified electrical storm (ES) at presentation, IHD, left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) functional class III / IV, and C-ABL as independent predictors of VT recurrence. In 135 patients undergoing repeated procedures, only C-ABL and ES were independent predictors of relapse. The identified independent predictors of mortality were C-ABL, ES, LVEF, age, and NYHA class III / IV. C-ABL survival benefit was only seen in patients with a previous ablation (P for interaction = 0.04). Mortality at 30 days was similar between NC-ABL and C-ABL (4% vs. 2%, respectively, P = 0.777), as was complication rate (10.3% vs. 15.1%, respectively, P = 0.336). CONCLUSION: A combined or sequential endo-epicardial VT ablation strategy was associated with lower VT recurrence and lower all-cause death in IHD and NICM patients undergoing repeated procedures. Both approaches seemed equally safe. CI - (c) 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature. FAU - Matos, Daniel AU - Matos D AUID- ORCID: 0000-0002-1554-6116 AD - Cardiology and Eletrophysiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Reinaldo Dos Santos, 2790-134, Carnaxide, Portugal. danieljnmatos@gmail.com. FAU - Adragao, Pedro AU - Adragao P AD - Cardiology and Eletrophysiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Reinaldo Dos Santos, 2790-134, Carnaxide, Portugal. FAU - Pisani, Cristiano AU - Pisani C AD - Heart Institute (Incor), University of Sao Paulo Medical School, Sao Paulo, Brazil. FAU - Hatanaka, Vinicius AU - Hatanaka V AD - Heart Institute (Incor), University of Sao Paulo Medical School, Sao Paulo, Brazil. FAU - Freitas, Pedro AU - Freitas P AD - Cardiology and Eletrophysiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Reinaldo Dos Santos, 2790-134, Carnaxide, Portugal. FAU - Costa, Francisco AU - Costa F AD - Cardiology and Eletrophysiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Reinaldo Dos Santos, 2790-134, Carnaxide, Portugal. FAU - Chokr, Muhiedinne AU - Chokr M AD - Heart Institute (Incor), University of Sao Paulo Medical School, Sao Paulo, Brazil. FAU - Hardy, Carina AU - Hardy C AD - Heart Institute (Incor), University of Sao Paulo Medical School, Sao Paulo, Brazil. FAU - Ferreira, Antonio Miguel AU - Ferreira AM AD - Cardiology and Eletrophysiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Reinaldo Dos Santos, 2790-134, Carnaxide, Portugal. FAU - Carmo, Pedro AU - Carmo P AD - Cardiology and Eletrophysiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Reinaldo Dos Santos, 2790-134, Carnaxide, Portugal. FAU - Laura, Sissy AU - Laura S AD - Heart Institute (Incor), University of Sao Paulo Medical School, Sao Paulo, Brazil. FAU - Morgado, Francisco AU - Morgado F AD - Cardiology and Eletrophysiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Reinaldo Dos Santos, 2790-134, Carnaxide, Portugal. FAU - Cavaco, Diogo AU - Cavaco D AD - Cardiology and Eletrophysiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Reinaldo Dos Santos, 2790-134, Carnaxide, Portugal. FAU - Mendes, Miguel AU - Mendes M AD - Cardiology and Eletrophysiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Reinaldo Dos Santos, 2790-134, Carnaxide, Portugal. FAU - Scanavacca, Mauricio AU - Scanavacca M AD - Heart Institute (Incor), University of Sao Paulo Medical School, Sao Paulo, Brazil. LA - eng PT - Journal Article DEP - 20220308 PL - Netherlands TA - J Interv Card Electrophysiol JT - Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing JID - 9708966 SB - IM CIN - J Interv Card Electrophysiol. 2023 Jan;66(1):95-97. PMID: 35403928 MH - Humans MH - Male MH - Middle Aged MH - Aged MH - Female MH - *Tachycardia, Ventricular MH - Stroke Volume MH - Ventricular Function, Left MH - *Myocardial Ischemia/complications MH - Treatment Outcome MH - *Catheter Ablation/methods MH - Recurrence OTO - NOTNLM OT - Catheter ablation OT - Electrical storm OT - Endocardial ablation OT - Epicardial ablation OT - Sudden cardiac death OT - Ventricular tachycardia EDAT- 2022/03/09 06:00 MHDA- 2023/02/18 06:00 CRDT- 2022/03/08 12:40 PHST- 2022/01/02 00:00 [received] PHST- 2022/02/28 00:00 [accepted] PHST- 2022/03/09 06:00 [pubmed] PHST- 2023/02/18 06:00 [medline] PHST- 2022/03/08 12:40 [entrez] AID - 10.1007/s10840-022-01175-3 [pii] AID - 10.1007/s10840-022-01175-3 [doi] PST - ppublish SO - J Interv Card Electrophysiol. 2023 Jan;66(1):87-94. doi: 10.1007/s10840-022-01175-3. Epub 2022 Mar 8.