Advances in VT ablation for arrhythmogenic cardiomyopathy: evidence, mapping and ablation strategies, and predictive...

Area of Science:

• Cardiology
• Genetics
• Electrophysiology

Background:

• Arrhythmogenic cardiomyopathy (ACM) presents diverse phenotypes (ARVC, ALVC, ABVC) linked to genetic mutations.
• Fibrosis is the primary substrate for ventricular tachycardia (VT) in ACM.
• VT ablation in ACM is challenging due to disease complexity and substrate variability.

Purpose of the Study:

• To critically review the role and efficacy of VT catheter ablation in arrhythmogenic cardiomyopathy.
• To assess current evidence, mapping/ablation techniques, and outcomes for VT ablation in ACM patients.

Main Methods:

• Review of current literature on VT ablation in arrhythmogenic cardiomyopathy.
• Analysis of mapping and ablation strategies, including endocardial-epicardial approaches.
• Evaluation of outcomes and predictors of success in VT ablation for ACM.

Main Results:

• Catheter ablation, especially combined approaches, can reduce VT burden in ACM.
• High recurrence rates of VT are observed, particularly in younger patients and those with extensive myocardial scarring.
• Predictors of ablation success require further elucidation in this complex patient group.

Conclusions:

• VT ablation is a valuable tool in managing arrhythmogenic cardiomyopathy but is limited by high recurrence rates.
• Further research is needed to optimize ablation strategies and improve long-term outcomes for ACM patients.
• Personalized risk stratification and tailored ablation techniques are crucial for successful VT management in ACM.