Outcomes of Catheter Ablation of Ventricular Tachycardia in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy
Why the study?
Does epicardial radiofrequency catheter ablation improve freedom from ventricular tachycardia compared to endocardial ablation in patients with ARVD/C?
Population
87 patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy who underwent a total of 175…
Comparison
Radiofrequency catheter ablation of ventricular… vs Endocardial RFA; procedures without 3D…
Design
Cohort
Follow-up
mean 88.3±66 months
Authors
Discussion
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Implication
Epicardial RFA was associated with longer VT-free survival than endocardial in ARVD/C; leaves open need for randomized confirmation.
Key Points
- To evaluate the efficacy of radiofrequency catheter ablation for ventricular tachycardia in arrhythmogenic right ventricular dysplasia/cardiomyopathy, with a focus on epicardial ablation and 3D electroanatomic mapping.
- Analyzed 87 patients with ARVD/C (mean age 38±13 years) undergoing 175 radiofrequency catheter ablation (RFA) procedures across 80 electrophysiology centers between 1992 and 2011.
- Assessed post-ablation VT recurrence and changes in VT burden over a mean follow-up period of 88.3±66 months, comparing epicardial versus endocardial ablation and 3D mapping use.
- Overall freedom from VT across all 175 procedures was 47% at 1 year, 21% at 5 years, and 15% at 10 years.
- Freedom from VT after epicardial RFA was 64% at 1 year and 45% at 5 years, significantly superior to endocardial RFA (P=0.021), while 3D electroanatomic mapping also significantly improved VT-free survival (P=0.016).
- Total VT burden significantly decreased following ablation irrespective of the specific procedural strategy employed (P<0.001).
Structured PICO
Does epicardial radiofrequency catheter ablation improve freedom from ventricular tachycardia compared to endocardial ablation in patients with ARVD/C?
P
Population
87 patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) who underwent a total of 175 radiofrequency catheter ablation procedures across 80 centers, mean age 38±13 years
I
Intervention
Radiofrequency catheter ablation (RFA) of ventricular tachycardia, including epicardial ablation and use of 3D electroanatomic mapping
C
Comparator
Endocardial RFA; procedures without 3D electroanatomic mapping
O
Outcome
Recurrence of ventricular tachycardia and effect of RFA on the burden of ventricular tachycardiahard clinical
In patients with ARVD/C, epicardial ablation and 3D electroanatomic mapping are associated with improved freedom from ventricular tachycardia, though long-term recurrence rates remain considerable.
Cite This Study
Philips et al. (2012) studied this question.