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Collateral injury of the conduction system during catheter ablation of septal substrate in nonischemic cardiomyopathy
Author(s) -
Muser Daniele,
Santangeli Pasquale,
Castro Simon A.,
Liang Jackson J.,
Enriquez Andres,
Liuba Ioan,
Magnani Silvia,
Garcia Fermin C.,
Arkles Jeffrey,
Supple Gregory G.,
Lin David,
Schaller Robert D.,
Kumareswaran Ramanan,
Zado Erica,
Tschabrunn Cory M.,
Dixit Sanjay,
Frankel David S.,
Callans David J.,
Marchlinski Francis E.
Publication year - 2020
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.14498
Subject(s) - medicine , ejection fraction , cardiology , catheter ablation , cardiomyopathy , ventricular tachycardia , ablation , electrical conduction system of the heart , heart failure , electrocardiography
In patients with nonischemic cardiomyopathy (NICM) little is known about the clinical impact of catheter ablation (CA) of septal ventricular tachycardia (VT) resulting in the collateral injury of the conduction system (CICS). Methods and Results Ninety‐five consecutive patients with NICM underwent CA of septal VT. Outcomes in patients with no baseline conduction abnormalities who developed CICS (group 1, n = 28 [29%]) were compared to patients with no CICS (group 2, n = 17 [18%]) and to patients with preexisting conduction abnormalities or biventricular pacing (group 3, n = 50 [53%]). Group‐1 patients were younger, had a higher left ventricular ejection fraction and a lower prevalence of New York Heart Association III/IV class compared to group 3 while no significant differences were observed with group 2. After a median follow‐up of 15 months, VT recurred in 14% of patients in group 1, 12% in group 2 ( P = .94) and 32% in group 3 ( P = .08) while death/transplant occurred in 14% of patients in group 1, 18% in group 2 ( P = .69) and 28% in group 3 ( P = .15). A worsening of left ventricular ejection fraction (LVEF) (median LVEF variation, −5%) was observed in group 1 compared to group 2 (median LVEF variation, 0%; P < .01) but not group‐3 patients (median LVEF variation, −4%; P = .08) with a consequent higher need for new biventricular pacing in group 1 (43%) compared to group 2 (12%; P = .03) and group 3 (16%; P < .01). Conclusions In patients with NICM and septal substrate, sparing the abnormal substrate harboring the conduction system provides acceptable VT control while preventing a worsening of the systolic function.