In-hospital Outcomes of Ventricular Tachycardia Ablation in Patients with Primary Non-Ischemic Cardiomyopathy Versus Non-Ischemic Cardiomyopathy Secondary to Systemic Infiltrative Diseases

In-hospital Outcomes of Ventricular Tachycardia Ablation in Patients with Primary Non-Ischemic Cardiomyopathy Versus Non-Ischemic Cardiomyopathy Secondary to Systemic Infiltrative Diseases | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 9 January 2025 V1 Latest version Share on In-hospital Outcomes of Ventricular Tachycardia Ablation in Patients with Primary Non-Ischemic Cardiomyopathy Versus Non-Ischemic Cardiomyopathy Secondary to Systemic Infiltrative Diseases Authors : Mohammad Ali Sheffeh 0000-0002-4345-4788 [email protected] , Omar Baqal , Shehroze Tabassum , Judy Sheffeh , Christopher V. DeSimone , Konstantinos C. Siontis , and Pasquale Santangeli 0000-0002-0023-9666 Authors Info & Affiliations https://doi.org/10.22541/au.173645695.55110942/v1 284 views 119 downloads Contents Abstract Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Background: Non-ischemic cardiomyopathies can be primary (p-NICM) which involves mainly the heart muscle or caused by systemic disease with heart muscle involvement as it is seen in systemic infiltrative diseases (i-NICM). There is limited data on the safety and in-hospital outcomes of ventricular tachycardia (VT) ablation in i-NICM. Methods: We identified patients who underwent VT ablation between 2018-2021 using the National Inpatient Sample Database. i-NICM include amyloidosis, hemochromatosis, or sarcoidosis. In-hospital complications include mortality, acute kidney injury (AKI), acute heart failure (AHF), bleeding, vasopressor use, blood transfusion and cardiac tamponade. Multivariate logistic regression analyses were performed. Results : There were 7,420 VT ablations, 7,235 had P-NICM and 185 had i-NICM. A multivariable analysis did not reveal any difference in mortality (adjusted odds ratio [aOR]: 0.81; 95% confidence interval 0.32-1.98; p=0.62), AHF aOR: 0.88 (0.41-1.81; p=0.69, AKI aOR:1.17 (0.83-1.65); p=0.36, blood transfusion aOR: 0.63 (0.25-1.59); p=0.33, vasopressor aOR: 0.86( 0.51-1.49); p=0.61 or pericardial effusion/ tamponade aOR: 1.16 (0.67-2.1); p=0.58 Figure Conclusion: Patients with i-NICM had similar in-hospital complications compared to P-NICM further supporting the safety of VT ablation in managing recurrent VT in patients with i-NICM. Background: Non-ischemic cardiomyopathies can be primary (p-NICM) which involves mainly the heart muscle or caused by systemic disease with heart muscle involvement as it is seen in systemic infiltrative diseases (i-NICM). There is limited data on the safety and in-hospital outcomes of ventricular tachycardia (VT) ablation in i-NICM. Methods: We identified patients who underwent VT ablation between 2018-2021 using the National Inpatient Sample Database. i-NICM include amyloidosis, hemochromatosis, or sarcoidosis. In-hospital complications include mortality, acute kidney injury (AKI), acute heart failure (AHF), bleeding, vasopressor use, blood transfusion and cardiac tamponade. Multivariate logistic regression analyses were performed. Results : There were 7,420 VT ablations, 7,235 had P-NICM and 185 had i-NICM. A multivariable analysis did not reveal any difference in mortality (adjusted odds ratio [aOR]: 0.81; 95% confidence interval 0.32-1.98; p=0.62), AHF aOR: 0.88 (0.41-1.81; p=0.69, AKI aOR:1.17 (0.83-1.65); p=0.36, blood transfusion aOR: 0.63 (0.25-1.59); p=0.33, vasopressor aOR: 0.86( 0.51-1.49); p=0.61 or pericardial effusion/ tamponade aOR: 1.16 (0.67-2.1); p=0.58 Figure Conclusion: Patients with i-NICM had similar in-hospital complications compared to P-NICM further supporting the safety of VT ablation in managing recurrent VT in patients with i-NICM. Brief Communication In-hospital Outcomes of Ventricular Tachycardia Ablation in Patients with Primary Non-Ischemic Cardiomyopathy Versus Non-Ischemic Cardiomyopathy Secondary to Systemic Infiltrative Diseases Mohammad Ali Sheffeh, M.D 1,2 ., Omar Baqal M.B.B.S 3 ., Shehroze Tabassum, M.D 4 ., Judy Sheffeh, M.D 1 ., Christopher V. DeSimone M.D., Ph.D., FHRS 2 ., Konstantinos C. Siontis M.D., FHRS 2 ., Pasquale Santangeli M.D., PhD. 5 . Affiliations 1 Department of Internal Medicine, Henry Ford, Warren, MI, USA 2 Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, USA 3 Department of Cardiovascular Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA 4 King Edward Medical University, Lahore, Pakistan 5 Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio Corresponding author’s : Mohammad Ali Sheffeh Email address: [email protected] Disclosures: No relevant disclosures reported by all authors Non-ischemic cardiomyopathies can be primary (p-NICM) caused by acquired, genetic or mixed etiologies that predominantly affects the heart muscle, or caused by a pathological involvement of the heart muscle as part of a systemic disease, as it is seen in infiltrative diseases (i-NICM). 1 The latter are relatively rare, typically associated with adjunctive non-cardiac end-organ dysfunction, and the underlying VT substrate can be more complex and less well-defined than p-NICM. These factors may affect the outcomes of VT ablation procedures. Most VT ablation studies have focused on p-NICM, and data on outcomes of VT ablation in i-NICM are scant. Analysis of data from large inpatient healthcare databases provides a unique opportunity to evaluate safety of VT ablation in i-NICM. We aimed to assess differences in in-hospital outcomes among p-NICM and i-NICM patients undergoing VT ablation. Hospitalization data were abstracted from the National Inpatient Sample Database which is the largest deidentified database in the United States. Patients ≥ 18 years of age with VT between 2018-2021 were identified using the International Classification of Diseases-10th Revision-Clinical Modification (ICD-10- CM) (I47.2x). Patients who underwent VT ablation were identified using the ICD procedure codes (02583ZZ, 02584ZZ, 025K3ZZ, 025K4ZZ, 025L3ZZ, 025L4ZZ). Patients with p-NICM (I42.x, I43.x) and i-NICM (sarcoidosis [D86.85], amyloidosis [E85.x], or hemochromatosis [E83.x]) were included. The study cohort was categorized into two groups; those who has the principal discharge diagnosis of VT and the second group is for those who their principal discharge diagnosis was not VT ( Figure ) . In-hospital complications included mortality, acute decompensated heart failure (AHF), acute kidney injury (AKI), bleeding, blood transfusion, vasopressor use, and pericardial effusion/tamponade. Multivariate analyses adjusted for age, sex, race, hypertension, diabetes, current smoking, history of heart failure, chronic kidney disease, peripheral artery disease, and chronic obstructive pulmonary disease were performed. The primary analysis was conducted on the first group and the secondary analysis on the second group. All analyses included discharge weights to generate weighted estimates for national extrapolation. The Institutional Review Board approval was not required as the data were deidentified. We identified 1,838,294 VT patients: 7,420 underwent VT ablation (185 with i-NICM and 7,235 with p-NICM). Those with i-NICM were younger compared to p-NICM [age 59 (±9) vs 63 (±13); p=0.02]. In the i-NICM group, 100 (54%) patients were white, 60 (32%) were black, whereas in the p-NICM group, 5,165 (72%) were white and 1040 (15%) were black (p=0.02). In-hospital mortality rate was 2.8% in i-NICM vs 3.1 in p-NICM; p=0.8. In the primary analysis, the multivariable analysis did not show any difference in in-hospital mortality between patients with i-NICM versus p-NICM (adjusted odds ratio [aOR]: 0.81; 95% confidence interval [CI] (0.32-1.98); p=0.62). There were no differences in AHF [aOR: 0.88; (0.61-1.27); p=0.51], AKI [aOR:1.17 (0.83-1.65); p=0.36), blood transfusion [aOR: 0.63 (0.25-1.59); p=0.33], vasopressors [aOR: 0.86 (0.51-1.49); p=0.61), or pericardial effusion/ tamponade [aOR: 1.16 (0.67-2.1); p=0.58). i-NICM were associated with lower risk of bleeding [aOR: 0.34; (0.13-0.84); p=0.02]. There were no differences between patients with i-NICM versus p-NICM in the secondary analysis ( Figure ). Our study provides novel insights into the in-hospital outcomes of patients with i-NICM undergoing VT ablation in a real-world setting. Despite the distinct pathophysiology of i-NICM, we showed no significant differences in in-hospital mortality and complications compared to p-NICM. To our knowledge, this is the largest study assessing the acute outcomes of i-NICM patients undergoing VT ablation as compared to p-NICM. Although VT ablation strategies have expanded and evolved to improve safety, data on the safety and outcomes of VT ablation for i-NICM remain limited to small observational case series, 2 3 further emphasizing the importance of analyzing large sample real-world databases to better inform the safety of these procedures. Our findings support the notion that VT ablation can be safely performed in these patients with similar complications compared to p-NICM. These findings are at variance with prior studies suggesting that patients with specific forms of i-NICM such as sarcoidosis had worse VT ablation complications compared to p-NICM. 4 These differences might be explained by a larger and more nationally representative cohort in addition to including other types of infiltrative diseases. The study’s main limitations are inherent to the data available in the NIS database, which include only in-hospital outcomes and, therefore, do not take into account important post-discharge outcomes including VT recurrence. However, the results of the present study remain of clinical importance as they provide nationwide representative data on the in-hospital outcomes following catheter ablation in largely underrepresented patients in prior VT ablation studies. Our findings support the appropriateness of considering VT ablation in i-NICM patients. Additional studies are needed to evaluate the differences in post-discharge ablation outcomes between the two groups. References 1. Chung FP, Lin CY, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Chao TF, Liao JN, Chang YT, et al. Ventricular arrhythmias in nonischemic cardiomyopathy. J Arrhythm . 2018;34:336-346. doi: 10.1002/joa3.120282. Papageorgiou N, Providência R, Bronis K, Dechering DG, Srinivasan N, Eckardt L, Lambiase PD. Catheter ablation for ventricular tachycardia in patients with cardiac sarcoidosis: a systematic review. Europace . 2018;20:682-691. doi: 10.1093/europace/eux0773. Compagnucci P, Dello Russo A, Gasperetti A, Schiavone M, Sehrawat O, Hasegawa K, Mohanty S, Liang JJ, Kapa S, La Fazia VM, et al. Substrate Characterization and Outcomes of Ventricular Tachycardia Ablation in Amyloid Cardiomyopathy: A Multicenter Study. Circ Arrhythm Electrophysiol . 2024;17:e012788. doi: 10.1161/circep.124.0127884. Tokuda M, Tedrow UB, Kojodjojo P, Inada K, Koplan BA, Michaud GF, John RM, Epstein LM, Stevenson WG. Catheter Ablation of Ventricular Tachycardia in Nonischemic Heart Disease. Circulation: Arrhythmia and Electrophysiology . 2012;5:992-1000. doi: doi:10.1161/CIRCEP.112.971341 Figure showing VT ablation outcomes in patients with i-NICM compared to P-NICM Information & Authors Information Version history V1 Version 1 09 January 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keyword clinical: catheter ablation – ventricular tachycardia Authors Affiliations Mohammad Ali Sheffeh 0000-0002-4345-4788 [email protected] Henry Ford Hospital View all articles by this author Omar Baqal Mayo Clinic Arizona View all articles by this author Shehroze Tabassum King Edward Medical University View all articles by this author Judy Sheffeh Henry Ford Hospital View all articles by this author Christopher V. DeSimone Mayo Clinic Department of Cardiovascular Medicine View all articles by this author Konstantinos C. Siontis Mayo Clinic Department of Cardiovascular Medicine View all articles by this author Pasquale Santangeli 0000-0002-0023-9666 Cleveland Foundation View all articles by this author Metrics & Citations Metrics Article Usage 284 views 119 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Mohammad Ali Sheffeh, Omar Baqal, Shehroze Tabassum, et al. In-hospital Outcomes of Ventricular Tachycardia Ablation in Patients with Primary Non-Ischemic Cardiomyopathy Versus Non-Ischemic Cardiomyopathy Secondary to Systemic Infiltrative Diseases. Authorea . 09 January 2025. DOI: https://doi.org/10.22541/au.173645695.55110942/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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