Long-Term Outcome with Catheter Ablation of Ventricular Tachycardia in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy (original) (raw)

2015, Circulation. Arrhythmia and electrophysiology

A rrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by diffuse or segmental loss of RV myocytes with replacement by fibrous and fatty tissue, which characteristically involves more extensively the epicardium (EPI) than the endocardium (ENDO). 1,2 This peculiar pathological process leads to islets of residual myocytes interspersed among adipocytes and fibrous tissue, providing an ideal milieu for reentrant ventricular tachycardia (VT). 3 The management of recurrent VT in ARVC is challenging with antiarrhythmic drug (AAD) therapy having limited efficacy. 4 Initial experiences with catheter ablation using an ENDO-only approach led to disappointing results. 5-7 Given the more extensive epicardial pathological substrate, 8,9 catheter ablation approaches using a combination of ENDO-EPI ablation have been recently shown to significantly improve VT-free survival at the short to the midterm follow-up. 9-12 Few data are available on the long-term outcome associated after ENDO-EPI ablative therapy in patients with ARVC and recurrent VT. In this study, we report our institutional experience on catheter ablation of VT in ARVC and document the long-term outcomes associated with extensive ENDO or ENDO-EPI VT ablation and substrate modification in these patients as it relates to VT recurrence and requirement for continued AAD therapy. Methods Study Population Sixty-two consecutive patients with ARVC and recurrent VT referred to the Hospital of the University of Pennsylvania for radiofrequency catheter ablation between 1998 and 2013 were included in the study. During the same study period, a total of 2716 VT ablation procedures were performed at our institution, of which 325 (12%) were epicardial; secular trends in the number of VT ablation procedures and epicardial procedures are shown in Figure I in the Data Supplement. All patients met the International Task Force criteria