Outcomes Associated With Catheter Ablation of Ventricular Tachycardia in Patients With Cardiac Sarcoidosis

IMPORTANCE Ventricular tachycardia (VT) is associated with high mortality in patients with cardiac sarcoidosis (CS), and medical management of CS-associated VT is limited by high failure rates. The role of catheter ablation has been investigated in small, single-center studies.OBJECTIVE To investigate outcomes associated with VT ablation in patients with CS.DESIGN, SETTING, AND PARTICIPANTS This cohort study from the Cardiac Sarcoidosis Consortium registry (2003-2019) included 16 tertiary referral centers in the US, Europe, and Asia. A total of 158 consecutive patients with CS and VT were included (33% female; mean [SD] age, 52 [11] years; 53% with ejection fraction [EF] <50%).EXPOSURES Catheter ablation of CS-associated VT and, as appropriate, medical treatment.MAIN OUTCOMES AND MEASURES Immediate and short-term outcomes included procedural success, elimination of VT storm, and reduction in defibrillator shocks. The primary long-term outcome was the composite of VT recurrence, heart transplant (HT), or death.RESULTS Complete procedural success (no inducible VT postablation) was achieved in 85 patients (54%). Sixty-five patients (41%) had preablation VT storm that did not recur postablation in 53 (82%). Defibrillator shocks were significantly reduced from a median (IQR) of 2 (1-5) to 0 (0-0) in the 30 days before and after ablation (P < .001). During median (IQR) follow-up of 2.5 (1.1-4.9) years, 73 patients (46%) experienced VT recurrence and 81 (51%) experienced the composite primary outcome. One- and 2-year rates of survival free of VT recurrence, HT, or death were 60% and 52%, respectively. EF less than 50% and myocardial inflammation on preprocedural F-18-fluorodeoxyglucose positron emission tomography were significantly associated with adverse prognosis in multivariable analysis for the primary outcome (HR, 2.24; 95% CI, 1.37-3.64; P = .001 and HR, 2.93; 95% CI, 1.31-6.55; P = .009, respectively). History of hypertension was associated with a favorable long-term outcome (adjusted HR, 0.51; 95% CI, 0.28-0.92; P = .02).CONCLUSIONS AND RELEVANCE In this observational study of selected patients with CS and VT, catheter ablation was associated with reductions in defibrillator shocks and recurrent VT storm. Preablation LV dysfunction and myocardial inflammation were associated with adverse long-term prognosis. These data support the role of catheter ablation in conjunction with medical therapy in the management of CS-associated VT.Cardiolog

Can After Sale Service Generate Brand Equity

Purpose – This research attempts to empirically expand the Aaker's consumer based brand equity model in hybrid business firms by incorporating after sales service as a new dimension. Exploring and understanding the drivers of consumer based brand equity in a hybrid business context will help in building industry specific competitive barriers and generating brand wealth. Design/methodology/approach – The data were collected from Pakistani adults using a structured questionnaire based on established scales. Convenience sampling was used to gather data from 205 respondents across the major cities of Pakistan. To test the proposed research model the data were analyzed using confirmatory factor analysis. Findings – The results support the proposed five‐factor model of consumer based brand equity for the automotive industry. The results support the notion that after sales service is related but is a separate dimension of consumer based brand equity in the automotive sector.Research limitations/implications – This proposed CBBE model was tested in the automotive sector of Pakistan. However, the automotive industry is special in the sense that it builds brands at dual level. This study only investigates consumer based brand equity at marque level. Future studies can expand on this work by investigating consumer based brand equity both at marque and model levels. Practical implications – The establishment of after sale services as a separate but independent dimension of consumer based brand equity for the hybrid business organizations provides a fresh reminder regarding the possibilities of new sources for building brand equity. Managers can focus on delivering excellent after sale services to build and enhance the equity of their brands in hybrid business organizations. Originality/value – This study expands Aaker's brand equity model by empirically establishing after sales service as a fifth dimension for the firms operating on hybrid business model