Arrhythmogenic Right Ventricular Cardiomyopathy With Extensive Abnormal Substrate: Is Isolation Possible?

Area of Science:

• Electrophysiology
• Cardiology
• Cardiac Ablation

Background:

• Arrhythmogenic right ventricular cardiomyopathy (ARVC) presents challenges in managing extensive right ventricular free wall (RVFW) abnormal substrate.
• Traditional large-area homogenization using combined epicardial and endocardial approaches is time-consuming and often insufficient for substrate modification in ARVC.

Purpose of the Study:

• To evaluate the feasibility and efficacy of isolating abnormal RVFW substrate in ARVC patients with ventricular tachycardia (VT).
• To explore a targeted approach for managing complex RV substrate in ARVC.

Main Methods:

• Eight ARVC patients with VT and extensive RVFW abnormal substrate underwent detailed voltage mapping during sinus rhythm.
• Circumferential linear lesions were created along the border zone of low-voltage areas on the RVFW for electrical isolation.
• Additional areas with fractionated or late potentials were homogenized; VT induction was performed pre- and post-ablation.

Main Results:

• Electrical isolation of the abnormal RVFW substrate was achieved in 62.5% of patients via endocardial approach alone and 37.5% with combined endocardial/epicardial approaches.
• All patients (100%) were rendered noninducible for VT post-ablation.
• At a median follow-up of 43 months, 87.5% of patients remained free of sustained VT.

Conclusions:

• Electrical isolation of the RVFW is a feasible and effective strategy for ARVC patients with extensive abnormal substrate.
• This technique provides a valuable therapeutic option for controlling VT in complex ARVC cases.