Abstract
AimsTo summarize our experience of radiofrequency catheter ablation (RFCA) for recurrent drug-refractory ventricular tachycardias (VTs) due to arrhythmogenic right ventricular cardiomyopathy (ARVC) in our center over the past 11 years and its related factors.Methods and ResultsWe reviewed 48 adults (mean age 39.9 ± 12.9 years, range: 14 to 65) who met the present ARVC diagnostic criteria and accepted RFCA for VTs from December 2004 to April 2016. The patients received a total of 70 procedures using two ablation approaches, the endocardial approach in 52 RFCAs, and the combined epicardial and endocardial approach (the combined approach) in 18 RFCAs. Kaplan-Meier survival analysis showed that the combined approach achieved better acute procedural success (p = 0.003) and better long-term outcomes (p = 0.028) than the endocardial approach. Patients who obtained acute procedural success with non-inducibility had better long-term outcomes (p < 0.001). COX regression of multivariate analysis showed that procedural success was the only factor that benefited long-term outcome, irrespective of the endocardial or the combined approach (p = 0.001). The rate of sudden cardiac death (SCD) in patients without procedural success was significantly higher than that in patients with procedural success (p = 0.005). All patients without implantable cardioverter defibrillator (ICD) implantation who had successful final RFCA survived.ConclusionsThe combined approach resulted in better procedural success and long-term VT-free survival compared with the endocardial approach in ARVC patients with recurrent VTs. Acute procedural success with non-inducibility was strongly related to better long-term VT-free survival and reduced SCD, irrespective of whether this was achieved by the endocardial approach or the combined approach.
Highlights
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetically determined cardiomyopathy which is characterized pathologically by fibro-fatty replacement of the right ventricular (RV) myocardium[1]
The combined approach resulted in better procedural success and long-term ventricular tachycardias (VTs)-free survival compared with the endocardial approach in ARVC patients with recurrent VTs
The combined approach was not associated with better VT-free survival than the endocardial approach (HR = 0.641, 95% CI = 0.224–1.839, p = 0.408)
Summary
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetically determined cardiomyopathy which is characterized pathologically by fibro-fatty replacement of the right ventricular (RV) myocardium[1]. Progressive and diffuse structural abnormalities can provide a substrate for reentrant ventricular tachycardias (VTs) which usually cause unstable hemodynamics. The guidelines recommend routine implantable cardioverter defibrillator (ICD) implantation in these patients, while radiofrequency catheter ablation (RFCA) is performed in patients with recurrent VTs despite anti-arrhythmic drugs[2]. With respect to mapping and ablation techniques, there are two approaches used to reach the myocardium, the endocardial approach and the epicardial approach. The long-term effects of RFCA in these patients are unclear.
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