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Original Investigation
November 17, 2021

Outcomes Associated With Catheter Ablation of Ventricular Tachycardia in Patients With Cardiac Sarcoidosis

Author Affiliations
  • 1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
  • 2Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia
  • 3Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands
  • 4Department of Electrophysiology, Care Hospitals, Hyderabad, India
  • 5Section of Cardiac Electrophysiology, Division of Cardiology, Brigham and Women’s Hospital, Boston, Massachusetts
  • 6Section of Cardiac Electrophysiology, University of Colorado, Aurora
  • 7Division of Cardiology, University of California, San Francisco
  • 8Division of Cardiology, University of Washington, Seattle
  • 9Department of Cardiology, King’s College Hospital National Health Service Foundation Trust, London, United Kingdom
  • 10Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 11Department of Cardiovascular Medicine, Kyorin University Hospital, Tokyo, Japan
  • 12Division of Cardiology, University of Minnesota, Minneapolis
  • 13Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
  • 14Heart Vascular Institute, Advocate Christ Medical Center, Oak Lawn, Illinois
  • 15Division of Cardiology, University of Maryland School of Medicine, Baltimore
  • 16Division of Cardiology, Virginia Commonwealth University, Richmond
  • 17Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor
  • 18Division of Cardiovascular Medicine, Cardiovascular Center, University of Michigan, Ann Arbor
JAMA Cardiol. Published online November 17, 2021. doi:10.1001/jamacardio.2021.4738
Key Points

Question  What outcomes are associated with ventricular tachycardia (VT) ablation in patients with cardiac sarcoidosis (CS)?

Findings  In a multicenter analysis of 158 patients with CS-associated VT undergoing catheter ablation, antiarrhythmic drug requirement and defibrillator shocks were significantly reduced, and VT storm was eliminated in 82% of patients with that presentation. LV dysfunction and myocardial inflammation were associated with adverse long-term prognosis postablation.

Meaning  These observational data suggest that catheter ablation procedures can play an important role in the management of CS-associated VT in conjunction with medical therapy, including for patients with VT storm.

Abstract

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.

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