Evaluation and management of ventricular tachycardia in patients with dilated cardiomyopathy

Abstract

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.