VT Recurrence After Ablation: Incomplete Ablation or Disease Progression? A Multicentric European Study.

Area of Science:

• Cardiology
• Electrophysiology
• Medical Research

Background:

• Ventricular tachycardia (VT) is a significant concern in arrhythmogenic RV cardiomyopathy (ARVC) and nonischemic cardiomyopathy (NICM).
• Understanding the causes of VT recurrence after ablation is crucial for improving patient management.

Purpose of the Study:

• To investigate whether VT recurrences in ARVC and NICM are primarily linked to incomplete radiofrequency ablation or ongoing disease progression.
• To differentiate the contributions of ablation gaps versus cardiomyopathy progression to VT recurrence.

Main Methods:

• Retrospective analysis of ARVC and NICM patients undergoing two substrate mapping procedures with ≥12 months between them.
• Disease progression defined by scar area increase (+5%), ventricular dilation (+25 mL), or ejection fraction decrease (-5%EF).
• Incomplete ablation defined by index VT recurrence or redo ablation in unablated scar regions without disease progression.

Main Results:

• Disease progression observed in 75% of patients, with ventricular remodeling in 70%.
• Scar progression occurred in 50% of patients; index VT recurrence was seen in 40%.
• Incomplete ablation was identified in 70% of redo procedures, indicating ablation gaps within the index scar.

Conclusions:

• Disease progression is common in ARVC and NICM, affecting scar and ventricular function.
• Incomplete index ablation is the predominant cause of VT recurrence, highlighting the need for more comprehensive ablation strategies.
• Further research into optimizing ablation techniques for these cardiomyopathies is warranted.