Incidence, Predictors, and Success of Ventricular Tachycardia Catheter Ablation in Arrhythmogenic Right Ventricular Cardiomyopathy (from the Nordic ARVC Registry)

Abstract

Catheter ablation may reduce ventricular tachycardia (VT) burden in arrhythmogenic right ventricular cardiomyopathy (ARVC) patients. However, little is known about factors predicting need for ablation. Therefore, we sought to investigate predictors and use of VT ablation and to evaluate the post-procedural outcome in ARVC patients. We studied 435 patients from the Nordic ARVC registry including 220 probands with definite ARVC according to the 2010 task force criteria and 215 mutation-carrying relatives identified through cascade screening. Patients were followed until first-time VT ablation, death, heart transplantation, or January 1st 2018. Additionally, patients undergoing VT ablation were further followed from the time of ablation for recurrent ventricular arrhythmias. The cumulative use of VT ablation was 4% (95%CI 3%-6%) and 11% (95%CI 8%-15%) after 1 and 10 years. All procedures were performed in probands in whom cumulative use was 8% (95%CI 5%-12%) and 20% (95%CI 15%-26%). In adjusted analyses among probands, only young age predicted ablation. In patients undergoing ablation, risk of recurrent arrhythmias was 59% (95%CI 44%-71%) and 74% (95%CI 59%-84%) 1 and 5 years after the procedure. Despite high recurrence rates, the burden of ventricular arrhythmias was reduced after ablation (p=0.0042). Young age, use of several antiarrhythmic drugs and inducibility to VT after ablation were associated with an unfavorable outcome. In conclusion, twenty percent of ARVC probands developed a clinical indication for VT ablation within 10 years whereas mutationcarrying relatives were without such need. Although the burden of ventricular arrhythmias decreased after ablation, risk of recurrence was substantial.

Feasibility of electroanatomic mapping and radiofrequency catheter ablation in Boxer dogs with symptomatic ventricular tachycardia

“…The success of VT ablation in humans is based on improvement of clinical signs and decreased arrhythmia burden and is not predicated on discontinuation of AAD. 72,73 Long-term clinical outcomes of RFCA in a large population of dogs will be important to evaluate its effects on survival, but was outside the scope of our study.…”

“…However, the need for continued antiarrhythmic treatment after RFCA does not invalidate the possible benefits of this intervention for dogs with symptomatic VT. Up to 82% of human ARVC patients continue to take AAD after RFCA 70,71 because of residual VT. The success of VT ablation in humans is based on improvement of clinical signs and decreased arrhythmia burden and is not predicated on discontinuation of AAD 72,73 . Long‐term clinical outcomes of RFCA in a large population of dogs will be important to evaluate its effects on survival, but was outside the scope of our study.…”

Efficacy of catheter ablation for premature ventricular contractions in arrhythmogenic right ventricular cardiomyopathy

“…[26][27][28] Enhanced auto- Two patients in our cohort experienced VT episodes for the first time 3 and 7 months after the ablation procedure. Interestingly, both patients were young (<18 years) and presented a high residual PVC burden (>14%) after ablation, which are characteristics that have been previously associated with a higher risk of sustained VT. 7,29 Nevertheless, whether VT was precipitated by the PVC ablation (proarrhythmic response) or was an incidental event is unclear. Further, the effect of CA on the likelihood of future sustained VT in patients with frequent PVCs is yet to be determined.…”

Predictors of long-term ventricular tachyarrhythmia recurrence after combined endo-epicardial ablation in patients with structural heart disease

“…В проведенном нами исследовании рецидивы ЖТ через 12 месяцев чаще встречались у пациентов с частичным острым эффектом аблации или при его отсутствии, а также у пациентов с неишемической кардио миопатией, что соответствует результатам опубликованных работ [25,26,27]. По результатам метаанализа 24 наблюдательных исследований было выявлено, что неиндуцируемость ЖТ после операции является предиктором отсутствия рецидива ЖТ у пациентов с неишемической кардиомиопатией, а также комбинированная эндо-эпикардиальная аблация снижает риск рецидива ЖТ у этой группы пациентов.…”