Outcomes and ventricular tachycardia recurrence characteristics after epicardial ablation of ventricular tachycardia in arrhythmogenic right ventricular dysplasia/cardiomyopathy

Role of Ventricular Tachycardia Ablation in Arrhythmogenic Right Ventricular Cardiomyopathy

“…25 Besides its diagnostic value, bipolar 3D-EVM also carries prognostic significance, as one study demonstrated that the presence and extent of bipolar low voltage areas is an independent predictor of arrhythmic events, over and above classical risk factors like clinical history, arrhythmic background and ventricular dysfunction, 19 and another study that the fragmented electrograms are significantly associated with arrhythmic events during follow-up. 26 Endocardial bipolar EVM can fail to detect low-voltage areas in about 25-30% of ARVC patients with VT, 19,27 and endocardial ablation approach provides only a modest freedom from VT recurrence. 27 This is related to the pathogenesis of the disease: as proved by autopsy and pathology studies, the wavefront of fibrofatty myocardial replacement progresses from the epicardium to the endocardium, so that the scar tissue can either involve the whole thickness of ventricular wall or be confined to epicardial/midmural layers, sparing the endocardial regions.…”

“…26 Endocardial bipolar EVM can fail to detect low-voltage areas in about 25-30% of ARVC patients with VT, 19,27 and endocardial ablation approach provides only a modest freedom from VT recurrence. 27 This is related to the pathogenesis of the disease: as proved by autopsy and pathology studies, the wavefront of fibrofatty myocardial replacement progresses from the epicardium to the endocardium, so that the scar tissue can either involve the whole thickness of ventricular wall or be confined to epicardial/midmural layers, sparing the endocardial regions. 28 Epicardial substrate in ARVC can be better identified by epicardial voltage mapping, which is particularly useful to guide catheter ablation in patients that have failed the endocardial approach.…”

Arrhythmogenic Right Ventricular Cardiomyopathy: From Pathophysiology to Diagnosis and Advances in Management

“…This is more successful when epicardial and endocardial approaches are combined (Figure 4). 73 Due to the progressive nature of disease, there may be recurrences but recent data suggests good outcomes, particularly reduction in long-term amiodarone therapy. 74,75 Heart failure (RV or LV) is treated with standard pharmacologic therapy including angiotensin-convertingenzyme inhibitors, angiotensin-II receptor blockers, beta-blockers and diuretics.…”

Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy – Three Decades of Progress –

“…CALKINS H Three studies have evaluated the outcomes of catheter ablation of VT in patients with ARVD/C. 28- 30 The first study 28 reported a cohort of 24 patients with ARVD/C who underwent VT ablation. These 24 patients underwent 48 ablation procedures at 29 different electrophysiology centers.…”

“…Most recently, a single center experience with epicardial VT ablation in patients with ARVD/C was published. 30 It included 30 ARVD/C patients who underwent endo-/epicardial mapping and epicardial catheter ablation of VT. ICD interrogations were evaluated for VT recurrence: 8 (27%) patients experienced VT recurrence after epicardial RFA and the VT-free survival was 83%, 76%, and 70% at 6, 12 and 24 months, respectively. A significant reduction in the VT burden was observed.…”