0523: Right ventricular dysfunction and epsilon wave: new predicting factors of recurrence of VT after radiofrequency catheter ablation in arrhythmogenic right ventricular dysplasia/cardiomyopathy

Abstract

Radiofrequency catheter ablation (RFCA) is increasingly used in the management of ventricular tachycardia (VT) in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVC/D) but it is associated with a high level of recurrences. To determine predictors associated with VT recurrence after RFCA in ARVC/D. This study included 85 consecutive patients referred to the Pitié Salpêtrière Hospital (Paris, France) who underwent a total of 149 RFCA procedures between 2000 and 2010. Predictors of recurrence of VT following RFCA were assessed by Cox regression. The mean age of the cohort was 36±13 years, 74 (87.1%) were men and 80 (95.2%) were proband. 70 (83.3%) experienced spontaneous VT before diagnosis. 30 (58.8%) patients required ≥2 procedures. In 13 (10.7%) patients, RFCA was performed through epicardial access. Over a mean follow- up of 114±60 months, the overall freedom from VT of the 149 procedures was 79%, and 56%, at 1 and 5 years, respectively. The presence of an epsilon wave and of right ventricular (RV) dysfunction (defined by RV angiography ejection fraction <40% or right area fractional change <35% by TTE) were associated with higher level of recurrences on multivariate analysis. The cumulative freedom from VT (Figure) in patients without RV dysfunction nor epsilon wave was 86% at 1 and 5 years, which was significantly longer than those without (76% and 47% respectively, P =0.003). Absence of RV dysfunction or of an epsilon wave are strongly associated with higher success after VT RFA in ARVC/D. Patients without those risk factors should therefore be considered as good candidates for VT ablation. Abstract 0523 – Figure: Survival analysis