Key result
Radiofrequency catheter ablation without a back-up ICD in selected ARVC patients resulted in 0 deaths or aborted cardiac arrests over a median 52.4 months, with VT recurrence in 29%.
Why the study?
The roles of ICDs and radiofrequency catheter ablation in patients with ARVC and well-tolerated monomorphic ventricular tachycardia remain debated.
Does radiofrequency catheter ablation without a back-up ICD prevent fatal arrhythmic events in selected patients with ARVC and well-tolerated MVT?
Cohort (n=65)
Yes
Does radiofrequency catheter ablation without a back-up ICD prevent fatal arrhythmic events in selected patients with ARVC and well-tolerated MVT?
In highly selected patients with ARVC and well-tolerated MVT, catheter ablation without a back-up ICD did not lead to fatal arrhythmic events over a median 52.4 months, suggesting it may be a safe alternative to ICD placement.
May support RCA without ICD in selected ARVC patients with tolerated MVT; leaves open need for prospective safety confirmation.
AIMS: The roles of implantable cardioverter-defibrillators (ICDs) and radiofrequency catheter ablation (RCA) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and well-tolerated monomorphic ventricular tachycardia (MVT) are debated. In this multicentre retrospective study, we aimed at reporting the outcome of selected patients with ARVC after RCA without a back-up ICD. METHODS AND RESULTS: Patients with ARVC who underwent RCA of well-tolerated MVT at 10 tertiary centres across 5 countries, without an ICD before and 3 months after RCA, without syncope or electrical storm, and with left ventricular ejection fraction ≥50% were included. In total, 65 ARVC patients [mean age 44.5 ± 13.2 years, 78% males] underwent RCA of MVT between 2003 and 2016. Clinical presentation was palpitations in 51 (80%) patients. One (2%) patient had >1 clinical MVT. At the ablative procedure, clinical MVTs (mean rate 185 ± 32 b.p.m.) were inducible in 50 (81%) patients. Epicardial ablation was performed in 19 (29%) patients. Complete acute success was achieved in 47 (72%) patients. After a median follow-up of 52.4 months (range 12.3-171.4), there was no death or aborted cardiac arrest, and VT recurred in 19 (29%) patients. Survival without VT recurrence was estimated at 88%, 80%, and 68%, 12, 36, and 60 months after RCA, respectively, and was significantly associated with the approach and the procedural outcome. CONCLUSION: In patients with ARVC, well-tolerated MVT without a back-up ICD did not lead to fatal arrhythmic event after RCA despite VT recurrences in some. Our data suggest that RCA may be an alternative to ICD in selected ARVC patients.
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Gandjbakhch et al. (2021) conducted a cohort in Arrhythmogenic right ventricular cardiomyopathy (ARVC) with well-tolerated monomorphic ventricular tachycardia (MVT) (n=65). Radiofrequency catheter ablation (RCA) without a back-up ICD was evaluated on Death or aborted cardiac arrest. Radiofrequency catheter ablation without a back-up ICD in selected ARVC patients resulted in 0 deaths or aborted cardiac arrests over a median 52.4 months, with VT recurrence in 29%.
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