Endocardial catheter ablation is effective for ARVC-related VT, with a 78.1% VT-free survival rate after the last procedure, though inducing ≥3 VTs predicts recurrence (HR 1.467; P=0.024).
Cohort (n=284)
What are the long-term outcomes of radiofrequency catheter ablation for ventricular tachycardia in patients with arrhythmogenic right ventricular cardiomyopathy?
Endocardial catheter ablation is effective for managing ventricular tachycardia in ARVC patients, though repeated procedures are often required, and the induction of multiple VTs predicts worse outcomes.
Hazard Ratio: 1.467 (95% CI 1.052–2.046)
valor p: p=0.024
AIMS: The study aims to describe the long-term outcome of radiofrequency catheter ablation for ventricular tachycardia (VT) in a large cohort arrhythmogenic right ventricular cardiomyopathy (ARVC) patients. METHODS AND RESULTS: Radiofrequency catheter ablation was performed in 284 ARVC patients due to VT between July 2000 and January 2019. An endocardial approach was used initially, with epicardial ablation procedures reserved for those patients who failed an endocardial ablation. Activation, entrainment, pace and substrate mapping strategies were used with regional ablation applied. A total of 393 ablation procedures were performed including endocardial approach only (n = 377) and endo and epicardial combined (n = 16). Right ventricular basal free wall was accounted as the primary substrate of VT in 258 (65.6%) patients. There were 81 patients underwent redo ablation procedure (second time = 81; ≥3 times = 28). New targets were observed in 68.8% of redo procedures. There were 171 VT recurrences and 19 deaths occurred during the follow-up. Ventricular tachycardia-free survival rate of the first, second, and last ablation procedure was 56.7%, 73.2%, and 78.1%, respectively. Multivariate analysis showed ≥3 induced VTs in the procedure was correlated with rehospitalized VT recurrence hazard ratio (HR) 1.467, 95% confidence interval (CI) 1.052-2.046; P = 0.024. For all-cause mortality, rehospitalized VT and ≥3 induced VTs were the independent risk factors (HR 2.954, 95% CI 1.8068.038; P = 0.034; HR 3.189, 95% CI 1.073-9.482; P = 0.037). CONCLUSION: Endocardial ablation is effective to ARVC VT though it may require repeated procedures. Induced multiple VTs was correlated with worse outcomes.
Liang et al. (Wed,) conducted a cohort in Arrhythmogenic right ventricular cardiomyopathy (ARVC) with ventricular tachycardia (VT) (n=284). Radiofrequency catheter ablation (≥3 induced VTs) was evaluated on Rehospitalized VT recurrence (HR 1.467, 95% CI 1.052-2.046, p=0.024). Endocardial catheter ablation is effective for ARVC-related VT, with a 78.1% VT-free survival rate after the last procedure, though inducing ≥3 VTs predicts recurrence (HR 1.467; P=0.024).
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