Combined Endo-Epicardial Approach and Scar Dechanneling Ablation in Arrhythmogenic Right Ventricular Cardiomyopathy

Abstract

A 47-year-old male diagnosed with Arrhythomogenic Right Ventricular Cardiomyopathy (ARVC) was referred for ablation due to recurrent ventricular tachycardia. Using the CARTO® 3 V6 system, both endocardial and epicardial voltage maps were acquired revealing an extensive epicardial scar with abundant local abnormal ventricular activities (LAVA) in distribution compatible with conducting channels. Epicardial scar dechanneling ablation allowed abolition of all LAVA’s. This case highlights the advantage of a combined endo-epicardial approach as a first-line therapy for ARVC, as well as of scar dechanneling ablation, which allowed elimination of all LAVA’s with a lesser extensive ablation.