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Evaluation and management of ventricular tachycardia in patients with dilated cardiomyopathy

Published:October 25, 2018DOI:https://doi.org/10.1016/j.hrthm.2018.10.028
      Recurrent ventricular tachycardia (VT) is an important cause of increased morbidity and mortality in patients with non–ischemic dilated cardiomyopathy (DCM). Current recommendations for the treatment of VT in patients with structural heart disease mainly rely on data derived from patients with ischemic cardiomyopathy. Unlike postinfarction ischemic cardiomyopathy, DCM comprises multiple different etiologies with variable disease progression and prognosis, which often requires an individualized approach to risk stratification and treatment. Prevention of VT recurrence in DCM is challenging, especially when antiarrhythmic drugs are ineffective or contraindicated. The implantable cardioverter-defibrillator is in fact able to terminate but not prevent recurrent VT. Catheter ablation is the criterion standard for substrate-based treatment in DCM. However, the available data from recent studies on VT ablation in DCM are inconsistent and morphological and functional features of the arrhythmogenic substrates are poorly defined. Advanced substrate-based research is required to increase the understanding of arrhythmia mechanisms and improve ablation outcome in this heterogeneous patient population.

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      References

        • Pinto Y.M.
        • Elliott P.M.
        • Arbustini E.
        • et al.
        Proposal for a revised definition of dilated cardiomyopathy, hypokinetic non-dilated cardiomyopathy, and its implications for clinical practice: a position statement of the ESC working group on myocardial and pericardial diseases.
        Eur Heart J. 2016; 37: 1850-1858
        • Japp A.G.
        • Gulati A.
        • Cook S.A.
        • Cowie M.R.
        • Prasad S.K.
        The diagnosis and evaluation of dilated cardiomyopathy.
        J Am Coll Cardiol. 2016; 67: 2996-3010
        • Ponikowski P.
        • Voors A.A.
        • Anker S.D.
        • et al.
        2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure.
        Eur Heart J. 2016; 37: 2129-2200
        • Middlekauff H.R.
        • Stevenson W.G.
        • Stevenson L.W.
        • Saxon L.A.
        Syncope in advanced heart failure: high risk of sudden death regardless of origin of syncope.
        J Am Coll Cardiol. 1993; 21: 110-116
        • Køber L.
        • Thune J.J.
        • Nielsen J.C.
        • et al.
        Defibrillator implantation in patients with nonischemic systolic heart failure.
        N Engl J Med. 2016; 375: 1221-1230
        • Priori S.
        • Blomstrom-Lundqvist C.
        • Mazzanti A.
        • et al.
        2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: the Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC).
        Europace. 2015; 17: 1601-1687
        • Stolfo D.
        • Ceschia N.
        • Zecchin M.
        • et al.
        Arrhythmic risk stratification in patients with idiopathic dilated cardiomyopathy.
        Am J Cardiol. 2018; 121: 1601-1609
        • Darma A.
        • Nedios S.
        • Kosiuk J.
        • Richter S.
        • Doering M.
        • Arya A.
        • Rolf S.
        • Sommer P.
        • Hindricks G.
        • Bollmann A.
        Differences in predictors of implantable cardioverter-defibrillator therapies in patients with ischaemic and non-ischaemic cardiomyopathies.
        Europace. 2016; 18: 405-412
        • Akoum N.W.
        • Sanders N.A.
        • Wasmund S.L.
        • Hamdan M.H.
        Irregular ventricular activation results in QT prolongation and increased QT dispersion: a new insight into the mechanism of AF-induced ventricular arrhythmogenesis.
        J Cardiovasc Electrophysiol. 2011; 22: 1249-1252
        • Goldberger J.J.
        • Subačius H.
        • Patel T.
        • Cunnane R.
        • Kadish A.H.
        Sudden cardiac death risk stratification in patients with nonischemic dilated cardiomyopathy.
        J Am Coll Cardiol. 2014; 63: 1879-1889
        • Brilakis E.S.
        • Friedman P.A.
        • Maounis T.N.
        • Rokas S.G.
        • Shen W.K.
        • Stamatelopoulos S.F.
        • Cokkinos D.V.
        Programmed ventricular stimulation in patients with idiopathic dilated cardiomyopathy and syncope receiving implantable cardioverter-defibrillators: a case series and a systematic review of the literature.
        Int J Cardiol. 2005; 98: 395-401
        • Piers S.R.D.
        • Askar S.F.A.
        • Venlet J.
        • Androulakis A.F.
        • Kapel G.F.L.
        • deRiva M.
        • Jongbloed J.J.
        • van Tintelen J.P.
        • Schalij M.J.
        • Pijnappels D.A.
        • Zeppenfeld K.
        QRS prolongation after premature stimulation is associated with polymorphic ventricular tachycardia in nonischemic cardiomyopathy.
        Heart Rhythm. 2016; 13: 860-869
        • Kawara T.
        • Derksen R.
        • deGroot J.R.
        • Coronel R.
        • Tasseron S.
        • Linnenbank A.C.
        • Hauer R.N.
        • Kirkels H.
        • Janse M.J.
        • deBakker J.M.
        Activation delay after premature stimulation in chronically diseased human myocardium relates to the architecture of interstitial fibrosis.
        Circulation. 2001; 104: 3069-3075
        • de Bakker J.M.
        • van Capelle F.J.
        • Janse M.J.
        • Tasseron S.
        • Vermeulen J.T.
        • Jonge N.
        • Lahpor J.R.
        Fractionated electrograms in dilated cardiomyopathy: origin and relation to abnormal conduction.
        J Am Coll Cardiol. 1996; 27: 1071-1078
        • Gulati A.
        • Jabbour A.
        • Ismail T.F.
        • et al.
        Association of fibrosis with mortality and sudden cardiac death in patients with nonischemic dilated cardiomyopathy.
        JAMA. 2013; 309: 896-908
        • McCrohon J.A.
        • Moon J.C.C.
        • Prasad S.K.
        • McKenna W.J.
        • Lorenz C.H.
        • Coats A.J.S.
        • Pennell D.J.
        Differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease using gadolinium-enhanced cardiovascular magnetic resonance.
        Circulation. 2003; 108: 54-59
        • Bogun F.M.
        • Desjardins B.
        • Good E.
        • Gupta S.
        • Crawford T.
        • Oral H.
        • Ebinger M.
        • Pelosi F.
        • Chugh A.
        • Jongnarangsin K.
        • Morady F.
        Delayed-enhanced magnetic resonance imaging in nonischemic cardiomyopathy: utility for identifying the ventricular arrhythmia substrate.
        J Am Coll Cardiol. 2009; 53: 1138-1145
        • Glashan C.A.
        • Androulakis A.F.A.
        • Tao Q.
        • et al.
        Whole human heart histology to validate electroanatomical voltage mapping in patients with non-ischaemic cardiomyopathy and ventricular tachycardia.
        Eur Heart J. 2018; 39: 2867-2875
        • Pogwizd S.M.
        Nonreentrant mechanisms underlying spontaneous ventricular arrhythmias in a model of nonischemic heart failure in rabbits.
        Circulation. 1995; 92: 1034-1048
        • Soejima K.
        • Stevenson W.G.
        • Sapp J.L.
        • Selwyn A.P.
        • Couper G.
        • Epstein L.M.
        Endocardial and epicardial radiofrequency ablation of ventricular tachycardia associated with dilated cardiomyopathy: the importance of low-voltage scars.
        Am J Cardiol. 2004; 43: 1834-1842
        • Piers S.R.D.
        • Tao Q.
        • van Huls van Taxis C.F.B.
        • Schalij M.J.
        • van der Geest R.J.
        • Zeppenfeld K.
        Contrast-enhanced MRI-derived scar patterns and associated ventricular tachycardias in nonischemic cardiomyopathy: implications for the ablation strategy.
        Circ Arrhythm Electrophysiol. 2013; 6: 875-883
        • Oloriz T.
        • Silberbauer J.
        • Maccabelli G.
        • et al.
        Catheter ablation of ventricular arrhythmia in nonischemic cardiomyopathy: anteroseptal versus inferolateral scar sub-types.
        Circ Arrhythm Electrophysiol. 2014; 7: 414-423
        • Oloriz T.
        • Wellens H.J.
        • Santagostino G.
        • Trevisi N.
        • Silberbauer J.
        • Peretto G.
        • Maccabelli G.
        • Della Bella P.
        The value of the 12-lead electrocardiogram in localizing the scar in non-ischaemic cardiomyopathy.
        Europace. 2016; 18: 1850-1859
        • Frankel D.S.
        • Tschabrunn C.M.
        • Cooper J.M.
        • Dixit S.
        • Gerstenfeld E.P.
        • Riley M.P.
        • Callans D.J.
        • Marchlinski F.E.
        Apical ventricular tachycardia morphology in left ventricular nonischemic cardiomyopathy predicts poor transplant-free survival.
        Heart Rhythm. 2013; 10: 621-626
        • Curtis J.P.
        • Sokol S.I.
        • Wang Y.
        • Rathore S.S.
        • Ko D.T.
        • Jadbabaie F.
        • Portnay E.L.
        • Marshalko S.J.
        • Radford M.J.
        • Krumholz H.M.
        The association of left ventricular ejection fraction, mortality, and cause of death in stable outpatients with heart failure.
        J Am Coll Cardiol. 2003; 42: 736-742
        • Arbustini E.
        • Disertori M.
        • Narula J.
        Primary prevention of sudden arrhythmic death in dilated cardiomyopathy: current guidelines and risk stratification.
        JACC Heart Fail. 2017; 5: 39-43
        • DiMarco A.
        • Anguera I.
        • Schmitt M.
        • et al.
        Late gadolinium enhancement and the risk for ventricular arrhythmias or sudden death in dilated cardiomyopathy: systematic review and meta-analysis.
        JACC Heart Fail. 2017; 5: 28-38
        • Halliday B.P.
        • Gulati A.
        • Ali A.
        • et al.
        Association between midwall late gadolinium enhancement and sudden cardiac death in patients with dilated cardiomyopathy and mild and moderate left ventricular systolic dysfunction.
        Circulation. 2017; 135: 2106-2115
        • Piers S.R.
        • Everaerts K.
        • van der Geest R.J.
        • Hazebroek M.R.
        • Siebelink H.M.
        • Pison L.A.
        • Schalij M.J.
        • Bekkers S.C.
        • Heymans S.
        • Zeppenfeld K.
        Myocardial scar predicts monomorphic ventricular tachycardia but not polymorphic ventricular tachycardia or ventricular fibrillation in nonischemic dilated cardiomyopathy.
        Heart Rhythm. 2015; 12: 2106-2114
        • Aus dem Siepen F.
        • Buss S.J.
        • Messroghli D.
        • et al.
        T1 mapping in dilated cardiomyopathy with cardiac magnetic resonance: quantification of diffuse myocardial fibrosis and comparison with endomyocardial biopsy.
        Eur Heart J Cardiovasc Imaging. 2015; 16: 210-216
        • Writing group
        • Document reading group
        EACVI Reviewers: This document was reviewed by members of the EACVI Scientific Documents Committee for 2014–2016 and 2016–2018. A joint procedural position statement on imaging in cardiac sarcoidosis: from the Cardiovascular, Inflammation & Infection Committees of the European Association of Nuclear Medicine, the European Association of Cardiovascular Imaging, and the American Society of Nuclear Cardiology.
        Eur Heart J Cardiovasc Imaging. 2017; 18: 1073-1089
        • Kim J.S.
        • Judson M.A.
        • Donnino R.
        • Gold M.
        • Cooper Jr., L.T.
        • Prystowsky E.N.
        • Prystowsky S.
        Cardiac sarcoidosis.
        Am Heart J. 2009; 157: 9-21
        • Blankstein R.
        • Osborne M.
        • Naya M.
        • et al.
        Cardiac positron emission tomography enhances prognostic assessments of patients with suspected cardiac sarcoidosis.
        J Am Coll Cardiol. 2014; 63: 329-336
        • Pasotti M.
        • Klersy C.
        • Pilotto A.
        • et al.
        Long-term outcome and risk stratification in dilated cardiolaminopathies.
        J Am Coll Cardiol. 2008; 52: 1250-1260
        • van Rijsingen I.
        • Arbustini E.
        • Elliott P.M.
        • et al.
        Risk factors for malignant ventricular arrhythmias in lamin A/C mutation carriers: a European cohort study.
        Am J Cardiol. 2012; 59: 493-500
        • Ackerman M.J.
        • Priori S.G.
        • Willems S.
        • et al.
        HRS/EHRA expert consensus statement on the state of genetic testing for the channelopathies and cardiomyopathies: this document was developed as a partnership between the Heart Rhythm Society (HRS) and the European Heart Rhythm Association (EHRA).
        Europace. 2011; 13: 1077-1109
        • Spezzacatene A.
        • Sinagra G.
        • Merlo M.
        • et al.
        Arrhythmogenic phenotype in dilated cardiomyopathy: natural history and predictors of life-threatening arrhythmias.
        J Am Heart Assoc. 2015; 4: e002149
        • Dalakas M.C.
        • Park K.Y.
        • Semino-Mora C.
        • Lee H.S.
        • Sivakumar K.
        • Goldfarb L.G.
        Desmin myopathy, a skeletal myopathy with cardiomyopathy caused by mutations in the desmin gene.
        N Engl J Med. 2000; 342: 770-780
        • van Tintelen J.P.
        • Van Gelder I.C.
        • Asimaki A.
        • et al.
        Severe cardiac phenotype with right ventricular predominance in a large cohort of patients with a single missense mutation in the DES gene.
        Heart Rhythm. 2009; 6: 1574-1583
        • Ortiz-Genga M.F.
        • Cuenca S.
        • DalFerro M.
        • et al.
        Truncating FLNC mutations are associated with high-risk dilated and arrhythmogenic cardiomyopathies.
        J Am Coll Cardiol. 2016; 68: 2440-2451
        • Yancy C.W.
        • Jessup M.
        • Bozkurt B.
        • et al.
        2013 ACCF/AHA guideline for the management of heart failure.
        Am J Cardiol. 2013; 62: e147-e239
        • Elming M.B.
        • Nielsen J.C.
        • Haarbo J.
        • et al.
        Age and outcomes of primary prevention implantable cardioverter-defibrillators in patients with nonischemic systolic heart failure.
        Circulation. 2017; 136: 1772-1780
        • Linde C.
        • Abraham W.T.
        • Gold M.R.
        • Daubert C.
        Cardiac resynchronization therapy in asymptomatic or mildly symptomatic heart failure patients in relation to etiology: results from the REVERSE (REsynchronization reVErses Remodeling in Systolic Left vEntricular Dysfunction) study.
        J Am Coll Cardiol. 2010; 56: 1826-1831
        • Wikstrom G.
        • Blomstrom-Lundqvist C.
        • Andren B.
        • Lonnerholm S.
        • Blomstrom P.
        • Freemantle N.
        • Remp T.
        • Cleland J.G.
        The effects of aetiology on outcome in patients treated with cardiac resynchronization therapy in the CARE-HF trial.
        Eur Heart J. 2009; 30: 782-788
        • Barsheshet A.
        • Wang P.J.
        • Moss A.J.
        • et al.
        Reverse remodeling and the risk of ventricular tachyarrhythmias in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy).
        J Am Coll Cardiol. 2011; 57: 2416-2423
        • Moss A.J.
        • Greenberg H.
        • Case R.B.
        • Zareba W.
        • Hall W.J.
        • Brown M.W.
        • Daubert J.P.
        • McNitt S.
        • Andrews M.L.
        • Elkin A.D.
        Long-term clinical course of patients after termination of ventricular tachyarrhythmia by an implanted defibrillator.
        Circulation. 2004; 110: 3760-3765
        • Tan V.H.
        • Wilton S.B.
        • Kuriachan V.
        • Sumner G.L.
        • Exner D.V.
        Impact of programming strategies aimed at reducing nonessential implantable cardioverter defibrillator therapies on mortality: a systematic review and meta-analysis.
        Circ Arrhythm Electrophysiol. 2014; 7: 164-170
        • Santangeli P.
        • Muser D.
        • Maeda S.
        • Filtz A.
        • Zado E.S.
        • Frankel D.S.
        • Dixit S.
        • Epstein A.E.
        • Callans D.J.
        • Marchlinski F.E.
        Comparative effectiveness of antiarrhythmic drugs and catheter ablation for the prevention of recurrent ventricular tachycardia in patients with implantable cardioverter-defibrillators: a systematic review and meta-analysis of randomized controlled trials.
        Heart Rhythm. 2016; 13: 1552-1559
        • Amiodarone Trials Meta-Analysis Investigators
        Effect of prophylactic amiodarone on mortality after acute myocardial infarction and in congestive heart failure: meta-analysis of individual data from 6500 patients in randomised trials.
        Lancet. 1997; 350: 1417-1424
        • Singh S.N.
        • Fletcher R.D.
        • Fisher S.G.
        • Singh B.N.
        • Lewis H.D.
        • Deedwania P.C.
        • Massie B.M.
        • Colling C.
        • Lazzeri D.
        Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia: survival trial of antiarrhythmic therapy in congestive heart failure.
        N Engl J Med. 1995; 333: 77-82
        • Connolly S.J.
        • Dorian P.
        • Roberts R.S.
        • et al.
        Comparison of beta-blockers, amiodarone plus beta-blockers, or sotalol for prevention of shocks from implantable cardioverter defibrillators: the OPTIC Study: a randomized trial.
        JAMA. 2006; 295: 165-171
        • Sapp J.L.
        • Wells G.A.
        • Parkash R.
        • et al.
        Ventricular tachycardia ablation versus escalation of antiarrhythmic drugs.
        N Engl J Med. 2016; 375: 111-121
        • Eckardt L.
        • Haverkamp W.
        • Göttker U.
        • Madeja M.
        • Johna R.
        • Borggrefe M.
        • Breithardt G.
        Divergent effect of acute ventricular dilatation on the electrophysiologic characteristics of d,l-sotalol and flecainide in the isolated rabbit heart.
        J Cardiovasc Electrophysiol. 1998; 9: 366-383
        • Merino J.L.
        Mechanisms underlying ventricular arrhythmias in idiopathic dilated cardiomyopathy: implications for management.
        Am J Cardiovasc Drugs. 2001; 1: 105-118
        • Bardy G.H.
        • Lee K.L.
        • Mark D.B.
        • et al.
        Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure.
        N Engl J Med. 2005; 352: 225-237
        • Tung R.
        • Vaseghi M.
        • Frankel D.S.
        • et al.
        Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: an International VT Ablation Center Collaborative Group study.
        Heart Rhythm. 2015; 12: 1997-2007
        • Aliot E.M.
        • Stevenson W.G.
        • Almendral-Garrote J.M.
        • et al.
        EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA).
        Europace. 2009; 11: 771-817
        • Dinov B.
        • Fiedler L.
        • Schönbauer R.
        • Bollmann A.
        • Rolf S.
        • Piorkowski C.
        • Hindricks G.
        • Arya A.
        Outcomes in catheter ablation of ventricular tachycardia in dilated nonischemic cardiomyopathy compared with ischemic cardiomyopathy: results from the Prospective Heart Centre of Leipzig VT (HELP-VT) Study.
        Circulation. 2014; 129: 728-736
        • Desjardins B.
        • Morady F.
        • Bogun F.
        Effect of epicardial fat on electroanatomical mapping and epicardial catheter ablation.
        J Am Coll Cardiol. 2010; 56: 1320-1327
        • Piers S.R.D.
        • Leong D.P.
        • van Huls van Taxis C.F.B.
        • Tayyebi M.
        • Trines S.A.
        • Pijnappels D.A.
        • Delgado V.
        • Schalij M.J.
        • Zeppenfeld K.
        Outcome of ventricular tachycardia ablation in patients with nonischemic cardiomyopathy: the impact of noninducibility.
        Circ Arrhythm Electrophysiol. 2013; 6: 513-521
        • Sacher F.
        • Tedrow U.B.
        • Field M.E.
        • Raymond J.-M.
        • Koplan B.A.
        • Epstein L.M.
        • Stevenson W.G.
        Ventricular tachycardia ablation: evolution of patients and procedures over 8 years.
        Circ Arrhythm Electrophysiol. 2008; 1: 153-161
        • Muser D.
        • Santangeli P.
        • Castro S.A.
        • et al.
        Long-term outcome after catheter ablation of ventricular tachycardia in patients with nonischemic dilated cardiomyopathy.
        Circ Arrhythm Electrophysiol. 2016; 9: e004328
        • Kumar S.
        • Barbhaiya C.R.
        • Sobieszczyk P.
        • et al.
        Role of alternative interventional procedures when endo- and epicardial catheter ablation attempts for ventricular arrhythmias fail.
        Circ Arrhythm Electrophysiol. 2015; 8: 606-615
        • Richardson T.
        • Lugo R.
        • Saavedra P.
        • et al.
        Cardiac sympathectomy for the management of ventricular arrhythmias refractory to catheter ablation.
        Heart Rhythm. 2018; 15: 56-62