Role of Ventricular Tachycardia Ablation in Arrhythmogenic Right Ventricular Cardiomyopathy

Abstract

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by progressive fibro-fatty replacement of the myocardium that represents the substrate for recurrent sustained ventricular tachycardia (VT). These arrhythmias characterize the clinical course of a sizeable proportion of patients and have significant implications for their quality of life and long-term prognosis. Antiarrhythmic drugs are often poorly tolerated and usually provide incomplete control of arrhythmia relapses. Catheter ablation is a potentially effective strategy to treat frequent VT episodes and ICD shocks in ARVC patients. The aims of this review are to discuss the electrophysiological and electroanatomic substrates of ventricular tachycardia in patients with ARVC and to analyze the role of catheter ablation in their management with particular reference to selection of patients, technical issues, potential complications and outcomes.

Understanding arrhythmogenic right ventricular cardiomyopathy

“…1 Recent studies, however, show better outcomes with the combined endocardial and epicardial approach compared with the endocardial approach alone, with a significantly improved short-and long-term efficacy. 1,3,9 The possibility of new arrhythmogenic foci created by progression and evolution of fibrofatty tissue and scar can arise and remains a limitation of both endocardial and epicardial approaches. Despite this limitation, catheter ablation remains an important aspect of management to improve quality of life in patients with ARVC and previously uncontrolled ventricular dysrhythmias.…”

“…Ablation is indicated for recurrent or sustained ventricular dysrhythmias refractory to conventional pharmacologic therapy or for patients who are unable to tolerate antiarrhythmic drugs. 9 Despite a high short-term success rate, endocardial ablation is associated with dysrhythmia recurrence in 50% to 70% of patients at 3 to 5 years follow-up. 1 Recent studies, however, show better outcomes with the combined endocardial and epicardial approach compared with the endocardial approach alone, with a significantly improved short-and long-term efficacy.…”

“…Catheter ablation is an effective therapy for many patients with ARVC. Ablation is indicated for recurrent or sustained ventricular dysrhythmias refractory to conventional pharmacologic therapy or for patients who are unable to tolerate antiarrhythmic drugs 9. Despite a high short-term success rate, endocardial ablation is associated with dysrhythmia recurrence in 50% to 70% of patients at 3 to 5 years follow-up 1.…”

“…Despite a high short-term success rate, endocardial ablation is associated with dysrhythmia recurrence in 50% to 70% of patients at 3 to 5 years follow-up 1. Recent studies, however, show better outcomes with the combined endocardial and epicardial approach compared with the endocardial approach alone, with a significantly improved short- and long-term efficacy 1,3,9. The possibility of new arrhythmogenic foci created by progression and evolution of fibrofatty tissue and scar can arise and remains a limitation of both endocardial and epicardial approaches.…”