PO73 Epicardial Ablation of Ventricular Tachycardia in a Young Patient with Biventricular Arrhythmogenic Right Ventricular Cardiomyopathy: A Case Report

Background Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a disorder that predisposes individuals to ventricular arrhythmias and sudden cardiac death. When medical therapy is inadequate, catheter ablation, including epicardial ablation, can be an effective treatment. This case describes successful epicardial ablation of ventricular tachycardia (VT) in an 18-year-old male with biventricular ARVC. Case Report An 18-year-old male, previously healthy and active in sports, had a syncopal event in September 2021. One week later, during exercise, he had pre-syncope with palpitations, which resolved after 5 minutes. Initial assessment revealed global hypokinesia of the left ventricle and right ventricular dysfunction on echocardiography. Holter monitoring under bisoprolol therapy showed frequent polymorphic PVCs (4875 events). Cardiac MRI revealed severe biventricular dilation with LVEF of 42% and RVEF of 34%. Myocardial edema was noted in the right ventricle, especially in the mid-inferior septum, along with extensive late gadolinium enhancement on the anterior-lateral and inflow regions of the left ventricle, distal anterior segment, and right ventricle (inferior and lateral walls), sparing the subendocardial layer, consistent with biventricular ARVC. Genetic testing was negative, and the patient was treated with ramipril and bisoprolol. In January 2022, sustained monomorphic VT was documented, and he was started on amiodarone, with an implantable cardioverter-defibrillator (ICD) placed for secondary prevention. Device monitoring showed stability, but in March 2024, pre-syncope recurred, and non-sustained VT was detected by ICD interrogation, despite maximum titration of bisoprolol and amiodarone therapy. On October 22, 2024, the patient underwent epicardial VT ablation at Hospital de Santa Maria. The procedure successfully eliminated the arrhythmic focus, and amiodarone dosage was reduced. Since the procedure, the patient has remained asymptomatic, with no recurrence of VT. Conclusion Epicardial ablation is an effective treatment for refractory VT in biventricular ARVC. It can reduce the arrhythmic burden and improve clinical outcomes when medical therapy fails.