Hybrid-Approach Ablation in Drug-Refractory Arrhythmogenic Right Ventricular Cardiomyopathy

Area of Science:

• Cardiology
• Electrophysiology
• Cardiac Surgery

Background:

• Management of ventricular arrhythmias (VAs) in arrhythmogenic right ventricular cardiomyopathy (ARVC) poses significant challenges, often requiring complex ablation strategies.
• The progressive nature of ARVC can lead to disappointing outcomes with standard catheter ablation techniques.

Purpose of the Study:

• To evaluate the effectiveness and outcomes of a thoracoscopic hybrid approach for catheter ablation of VAs in drug-refractory ARVC patients.
• To assess the recurrence rate and long-term freedom from significant arrhythmic events after hybrid ablation.

Main Methods:

• A case series of 16 patients with drug-refractory ARVC undergoing endocardial and/or epicardial catheter ablation via a thoracoscopic hybrid approach.
• Analysis of VA recurrence and time to freedom from clinically significant arrhythmias after a mean follow-up of 5.16 years.

Main Results:

• A 31.25% recurrence rate of VAs was observed, with a significantly higher recurrence in patients who had undergone previous ablations (80%) compared to those receiving hybrid ablation as a first approach (9.09%).
• Despite recurrence, all patients experienced a significant reduction in arrhythmic burden, achieving a mean of 4.65 years of freedom from symptomatic VAs or implantable cardioverter-defibrillator therapies.

Conclusions:

• The thoracoscopic hybrid approach offers a viable strategy for managing VAs in ARVC patients, improving arrhythmic burden even with recurrence.
• A multidisciplinary approach incorporating advanced mapping and ablation technologies is crucial for optimizing outcomes in these complex patients.