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Should all patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy undergo epicardial catheter

Andreas Müssigbrodt1, Elena Efimova2, Helge Knopp2

  • 1Department of Electrophysiology, Heart Centre, University of Leipzig, Strümpellstrasse 39, 04289, Leipzig, Germany. andreas.muessigbrodt@gmail.com.

Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing
|December 1, 2016
PubMed

Insights

An inducibility-guided approach to ventricular tachycardia (VT) ablation in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) avoids unnecessary epicardial procedures. This strategy shows comparable long-term VT recurrence rates to combined endo- and epicardial ablation.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Epicardial radiofrequency catheter ablation is a standard treatment for arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) with recurrent ventricular tachycardia (VT).
  • The study hypothesizes that VT inducibility can guide ablation strategy and influence long-term outcomes.
  • Epicardial ablation was reserved for cases where VT remained inducible after endocardial ablation.

Purpose of the Study:

  • To evaluate an inducibility-guided ablation approach for VT in ARVD/C patients.
  • To compare long-term results of endocardial versus combined endo-epicardial ablation guided by VT inducibility.

Main Methods:

  • A cohort of 45 ARVD/C patients undergoing VT ablation was analyzed from a registry.
  • All patients initially underwent endocardial VT ablation.
  • Epicardial ablation was performed only if VT remained inducible post-endocardial ablation.

Main Results:

  • After endocardial ablation, 53.3% of patients remained inducible, prompting epicardial ablation in 48.9%.
  • Overall non-inducibility was achieved in 84.4% of patients post-ablation.
  • VT recurrence-free rates at mean follow-up of 31 months were similar between groups (59.1% endo-epicardial vs. 56.5% endocardial).

Conclusions:

  • An inducibility-guided VT ablation strategy in ARVD/C can prevent unnecessary epicardial procedures.
  • This approach offers an alternative to routine combined endo- and epicardial ablation.
  • VT inducibility is a valuable factor in tailoring ablation strategies for ARVD/C patients.
Abstract

Keywords:
Arrhythmogenic right ventricular dysplasia/cardiomyopathyCatheter ablationEndocardialEpicardialInducibilityRadiofrequencyVentricular tachycardia

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