Key result
Combined endo-epicardial VT ablation cuts recurrence ~30% vs endocardial alone in ARVC but increases complications.
Why the study?
Both endocardial and combined endo-epicardial VT ablation are used in ARVC, but data directly comparing the two approaches are limited.
Does combined endo-epicardial catheter ablation reduce VT/VF recurrence compared to endocardial ablation alone in patients with arrhythmogenic right ventricular cardiomyopathy?
Does combined endo-epicardial catheter ablation reduce VT/VF recurrence compared to endocardial ablation alone in patients with arrhythmogenic right ventricular cardiomyopathy?
Answers are grounded in this paper and cite their sources.
In patients with ARVC, a combined endo-epicardial VT ablation approach significantly reduces VT recurrence compared to endocardial ablation alone, though it carries a higher risk of major complications.
Background/Introduction Both endocardial and combined endo-epicardial ventricular tachycardia (VT) ablation approaches have been utilized in patients with ARVC. Although there are data from single-center studies on both these approaches, there is paucity of data on direct comparison of these 2 ablation approaches. Methods We searched major electronic databases for studies that had compared endocardial ablation to combined endo-epicardial VT ablation in patients with ARVC. The outcomes were pooled using a random-effects model, and the results were expressed as risk ratios (RR) with corresponding 95% confidence intervals (CI). Statistical heterogeneity was assessed using the I2 statistic and all analyses were conducted using RStudio. Primary outcomes: VT/VF recurrence Secondary/safety outcomes: Major complications Results From the 11 studies utilized in our meta-analysis, a total of 633 patients were included. Endo-epicardial ablation was associated with a 30% relative risk reduction (RRR) in ventricular arrhythmia (VA) recurrence when compared with endocardial ablation alone (risk ratio [RR], 0.70; 95% confidence interval [CI], 0.53-0.93; P < .0001). There was also an absolute risk reduction (ARR) for ventricular tachycardia recurrence of 28.34%, with a number needed to treat (NNT) of 3.53. However, the endo-epicardial ablation group was also associated with a higher risk of major complications when compared to the endocardial ablation group alone (risk ratio [RR], 3.58; 95% confidence interval [CI], 1.01-12.71; P = 0.37). This was associated with an attributable risk (AR) of 2.81%, and a number needed to harm (NNH) of 35.58. Conclusion(s) Through our meta-analysis, we observed that a combined endocardial-epicardial VT ablation approach was associated with a significant reduction in VT recurrence when compared with endocardial ablation alone. On balance, endo-epicardial ablation is also associated with greater risk of major complications when compared with endocardial ablation alone, thus shedding light on avenues for further study of this approach.
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Mirza et al. (2025) studied this question. Combined endo-epicardial VT ablation reduced VT recurrence by 30% (RR 0.70) but increased major complications risk (RR 3.58) versus endocardial ablation alone in ARVC patients.
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