Catheter Ablation Compared to Medical Therapy for Ventricular Tachycardia in Sarcoidosis: Outcomes and Hospital Readmissions in a Nationwide Cohort Study

Background Patients with cardiovascular manifestations of sarcoidosis are at an increased risk for ventricular arrhythmias (VA) and sudden cardiac death. Catheter ablation (CA) for ventricular tachycardia (VT) can be a useful treatment strategy, however, few studies have compared CA to medical therapy in this patient population. Objective To assess in-hospital outcomes and unplanned readmissions following CA for VT compared to medical therapy in patients with sarcoidosis. Methods Using ICD-9 and ICD-10 diagnostic and procedural codes, data was obtained from the Nationwide Readmissions Database between January 2010 and December 2019 to identify patients with a diagnosis of sarcoidosis admitted for VT either undergoing CA or medical therapy. Primary endpoints were 30-day unplanned hospital readmissions as well as a composite endpoint of inpatient mortality, cardiogenic shock, and cardiac arrest. Complications at index hospitalization and causes of readmission were also identified. Results Among a total of 1,581 patients, 1,349 patients with sarcoidosis and a diagnosis of VT were managed medically compared to 232 that underwent CA. Readmission rates at 30 days were 10.8% and 8.0%, respectively (p=0.266). In univariate analysis, the composite endpoint of mortality, cardiac arrest and cardiogenic shock trended in favor of ablation (7.4% vs 11.7%, p=0.067). In the subgroup of patients undergoing elective CA for VT, there was an improvement in the univariate composite of mortality, cardiac arrest, and cardiogenic shock (3.2% vs. 11.7%, p=0.039). After multivariable adjustment, patients undergoing elective CA were less likely to be readmitted within 30-days (OR 0.23 [95% CI 0.05,0.90] p=0.042). The most common cause of readmission were VA in both groups, however, those undergoing elective CA were less likely to be readmitted for VA compared to non-elective ablation. Complications in the CA group included cardiac tamponade (4.7%), vascular complications (2.6%), and hematomas (3.0%). Conclusion In a national database of patients admitted with sarcoidosis and VT, when compared to medical therapy, CA results in a similar 30-day readmission rate with a trend towards reduction in the univariate composite endpoint of inpatient mortality, cardiogenic shock, and cardiac arrest. Patients undergoing elective VT ablation have a superior univariate outcome in the primary composite endpoint and were less likely to be readmitted within 30-days in adjusted analysis compared to medical therapy. Procedure related complications were low in the ablation group. The findings of short-term safety compared to medical therapy in addition to early intervention adds further support to an elective CA approach. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by New York University Langone Medical Center's Heart Rhythm Center and the Leon H. Charney Division of Cardiology. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: As the Nationwide Readmissions Database is a publicly available deidentified database, institutional review board approval and informed consent were not required for this study. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable The Nationwide Readmissions Database is publicly available data set sponsored by the Agency for Healthcare Research and Quality as part of the Healthcare Cost and Utilization Project.