Outcomes of Ventricular Tachycardia Ablation Versus Class III Antiarrhythmics as First-Line Therapy in Patients With Sarcoidosis and Ventricular Tachycardia

Document Type

Conference Proceeding

Publication Date

4-7-2026

Publication Title

Journal of the American College of Cardiology

Abstract

BACKGROUND Ventricular tachycardia (VT) is a common manifestation in patients with cardiac sarcoidosis. Catheter ablation is more effective than Class III antiarrhythmic drugs (AAD) in managing patients with VT, especially in refractory cases. However, its role in patients with sarcoidosis and VT remains incompletely studied. METHODS Using the TriNetX network, we identified patients with sarcoidosis and VT between 2014 and 2019. Patients were categorized into two cohorts: those with VT ablation and those with Class III AAD as first-line therapy for VT. Outcomes, including all-cause hospitalization, all-cause mortality, cardiac arrest, and heart failure exacerbation, were assessed at 1 year, 3 years, and 5 years follow-up. RESULTS Among 3,671 eligible patients, 326 patients (mean age 59.9 ± 11.2 years) who had VT ablation and 326 patients (mean age 59.7 ± 12.6 years) who had Class III AAD as first-line therapy for VT in sarcoidosis had similar propensity scores, were included in the analysis. At 1 year follow-up, compared to Class III AAD, VT ablation demonstrated a lower hazard ratio (HR) in all-cause hospitalization (HR: 0.48; CI: 0.35-0.66, p< 0.01), all-cause mortality (HR: 0.31; CI: 0.12-0.77, p=0.01), cardiac arrest (HR: 0.39; CI: 0.20-0.77, p=0.01), and heart failure exacerbation (HR: 0.23; CI: 0.11-0.48, p< 0.01). Similarly, at 3 years and 5 years follow-ups, the VT ablation group showed a lower hazard ratio in all-cause hospitalization (3-year, HR: 0.50; CI: 0.38-0.66, p< 0.01; 5-year, HR: 0.52; CI: 0.40-0.67, p< 0.01), all-cause mortality (HR: 0.24; CI: 0.12-0.50, p< 0.01; HR: 0.27; CI: 0.14-0.51, p< 0.01), cardiac arrest (HR: 0.43; CI: 0.25-0.76, p< 0.01; HR: 0.43; CI: 0.25-0.73, p< 0.01), and heart failure exacerbation (HR: 0.23; CI: 0.13-0.43, p< 0.01; HR: 0.30; CI: 0.17-0.50, p< 0.01) compared to Class III AAD group. CONCLUSION Patients with sarcoidosis and VT demonstrated better outcomes with VT ablation compared to Class III AAD, including lower all-cause hospitalization, all-cause mortality, cardiac arrest, and heart failure exacerbation at 1-, 3-, and 5-year follow-ups.

Volume

87

Issue

13 Suppl

First Page

A79

Comments

American College of Cardiology 75th Annual Scientific Session & Expo, March 28-30, 2026, New Orleans, LA

Last Page

A80

DOI

10.1016/j.jacc.2026.02.198

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