Scar Homogenization Versus Limited-Substrate Ablation in Patients With Nonischemic Cardiomyopathy and Ventricular Tachycardia

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dc.authoridDello Russo, Antonio/0000-0001-7737-421X|Casella, Michela/0000-0002-5322-1742|Tondo, Claudio/0000-0002-8500-8313|Themistoclakis, Sakis/0000-0002-7998-7113|Santangeli, Pasquale/0000-0002-0023-9666
dc.contributor.authorGokoglan, Yalcin
dc.contributor.authorMohanty, Sanghamitra
dc.contributor.authorGianni, Carola
dc.contributor.authorSantangeli, Pasquale
dc.contributor.authorTrivedi, Chintan
dc.contributor.authorGunes, Mahmut F.
dc.contributor.authorBai, Rong
dc.date.accessioned2025-10-24T18:09:03Z
dc.date.available2025-10-24T18:09:03Z
dc.date.issued2016
dc.departmentMalatya Turgut Özal Üniversitesi
dc.description.abstractBACKGROUND Scar homogenization improves long-term ventricular arrhythmia-free survival compared with standard limited-substrate ablation in patients with post-infarction ventricular tachycardia (VT). Whether such benefit extends to patients with nonischemic cardiomyopathy and scar-related VT is unclear. OBJECTIVES The aim of this study was to assess the long-term efficacy of an endoepicardial scar homogenization approach compared with standard ablation in this population. METHODS Consecutive patients with dilated nonischemic cardiomyopathy (n = 93), scar-related VTs, and evidence of low-voltage regions on the basis of pre-defined criteria on electroanatomic mapping (i.e., bipolar voltage <1.5 mV) underwent either standard VT ablation (group 1 [n = 57]) or endoepicardial ablation of all abnormal potentials within the electroanatomic scar (group 2 [n = 36]). Acute procedural success was defined as noninducibility of any VT at the end of the procedure; long-term success was defined as freedom from any ventricular arrhythmia at follow-up. RESULTS Acute procedural success rates were 69.4% and 42.1% after scar homogenization and standard ablation, respectively (p = 0.01). During a mean follow-up period of 14 +/- 2 months, single-procedure success rates were 63.9% after scar homogenization and 38.6% after standard ablation (p = 0.031). After multivariate analysis, scar homogenization and left ventricular ejection fraction were predictors of long-term success. During follow-up, the rehospitalization rate was significantly lower in the scar homogenization group (p = 0.035). CONCLUSIONS In patients with dilated nonischemic cardiomyopathy, scar-related VT, and evidence of low-voltage regions on electroanatomic mapping, endoepicardial homogenization of the scar significantly increased freedom from any recurrent ventricular arrhythmia compared with a standard limited-substrate ablation. However, the success rate with this approach appeared to be lower than previously reported with ischemic cardiomyopathy, presumably because of the septal and midmyocardial distribution of the scar in some patients. (C) 2016 by the American College of Cardiology Foundation.
dc.identifier.doi10.1016/j.jacc.2016.08.033
dc.identifier.endpage1998
dc.identifier.issn0735-1097
dc.identifier.issn1558-3597
dc.identifier.issue18
dc.identifier.pmid27788854
dc.identifier.scopus2-s2.0-85021335528
dc.identifier.scopusqualityQ1
dc.identifier.startpage1990
dc.identifier.urihttps://doi.org/10.1016/j.jacc.2016.08.033
dc.identifier.urihttps://hdl.handle.net/20.500.12899/3447
dc.identifier.volume68
dc.identifier.wosWOS:000386828100009
dc.identifier.wosqualityQ1
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.language.isoen
dc.publisherElsevier Science Inc
dc.relation.ispartofJournal Of The American College Of Cardiology
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/closedAccess
dc.snmzKA_20251023
dc.subjectelectroanatomic mapping; inducibility; low-voltage areas; ventricular arrhythmia
dc.titleScar Homogenization Versus Limited-Substrate Ablation in Patients With Nonischemic Cardiomyopathy and Ventricular Tachycardia
dc.title.alternativeScar Homogenization Versus Limited-Substrate Ablation in Patients With Nonischemic Cardiomyopathy and Ventricular Tachycardia
dc.typeArticle

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