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Ablation of Ventricular Arrhythmias in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy: Arrhythmia-Free Survival After Endo-Epicardial Substrate Based Mapping and Ablation
Study Questions:
How often are patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) rendered free of ventricular tachycardia (VT) by radiofrequency catheter ablation (RFCA)?
Methods:
The subjects of this prospective, multicenter study were 49 patients (mean age 36 years) with ARVD/C and sustained VT. All patients had an implantable cardioverter-defibrillator (ICD). At the operator’s discretion, RFCA was performed endocardially (group 1, n = 23) or endocardially and epicardially (group 2, n = 26). All inducible VTs, abnormal electrograms, and scar regions were targeted for RFCA. The endpoint was noninducibility of sustained monomorphic VT. Serial ICD interrogations were performed during follow-up.
Results:
A mean of two VTs (range 1-5) were ablated and the endpoint of noninducibility was achieved in all patients. Frequent (>10/minute) premature ventricular complexes (PVCs) were present at the end of the procedure more often in patients in group 1 than group 2 (52% vs. 15%). Freedom from VT off antiarrhythmic drug therapy at a mean of 3.3 years of follow-up was significantly higher in group 2 (69%) than in group 1 (22%). Freedom from VT including patients on drug therapy also was higher in group 2 than in group 1 (85% vs. 52%). Frequent PVCs post-ablation were predictive of recurrent VT.
Conclusions:
The authors concluded that compared to an endocardial approach, combined endocardial-epicardial RFCA of VT more often results in freedom from VT in patients with ARVD/C.
Perspective:
Epicardial mapping and ablation in the pericardial space often is reserved for redo procedures after endocardial ablation has been proven ineffective. The results strongly suggest that a combined endocardial-epicardial approach should be the primary strategy for RFCA of VT in patients with ARVD/C.
Keywords: Arrhythmogenic Right Ventricular Dysplasia, Defibrillators, Catheter Ablation, Tachycardia
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