Ablation compared with drug therapy for recurrent ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy: Results from a multicenter study

Abstract

Background: The comparative efficacy of antiarrhythmic drug therapy (AAD) versus ventricular tachycardia (VT) ablation in arrhythmogenic right ventricular cardiomyopathy (ARVC) is unknown. Objectives: We compared outcomes of AAD and/or beta blocker (BB) therapy to VT ablation (with AAD/BB) in ARVC patients with recurrent VT. Methods: In a multicenter retrospective study, 110 ARVC patients (38±17 years, 83% male) with a minimum of 3 VT episodes were included; 77 (70%) were initially treated with AAD/BB and 32 (29%) underwent ablation. Subsequently, 43 of the 77 patients treated with AAD/BB-only also underwent ablation. Overall, 75 patients underwent ablation. Results: When comparing initial AAD/BB therapy (n=77) and VT ablation (n=32) after ≥3 VT episodes, a single ablation procedure rendered 35% of patients free of VT at 3 years compared to 28% of AAD/BB-only treated patients (p=0.46). Of the 77 AAD/BB treated patients, 43 subsequently had ablation. For all 75 patients who had ablation, 56% were VT-free at 3 years after the last ablation. Epicardial ablation was used in 53% and was associated with lower VT recurrence after the last ablation (endocardial/epicardial vs. endocardial-only; 71% vs. 47% three-year VT-free survival, p=0.05). Importantly, there was no difference in survival free of death or transplantation between the ablation-and AAD/BB-only treated patients (p=0.61). Conclusion: Amongst ARVC patients with a high VT burden, mortality and transplantation-free survival is not significantly different between drug-and ablationtreated patients. These patients have a high risk of recurrent VT despite drug therapy. Combined endocardial/epicardial ablation is associated with reduced VT recurrence compared to endocardial-only ablation.

Catheter ablation of electrical storm in patients with arrhythmogenic right ventricular cardiomyopathy

“…Fatal outcomes were all related to ARVC-related structural dysfunction, and we found no temporal association between VT recurrence and mortality or HT. These results are in line with a recent multicenter observational study finding no difference in survival in RFCAversus AAD-treated patients despite a significantly reduced VT burden in the former group 22 .…”

The year in cardiology: arrhythmias and pacing

“…A retrospective study of 110 patients demonstrated CA of recurrent VT in patients with arrhythmogenic ventricular cardiomyopathy is no more effective than drugs but is more likely to be successful if both epicardial and endocardial approaches are used. 62…”

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

“…Moreover, several studies have reported varying results on the procedural efficacy. [3][4][5][6][7][8][9][10][11][12] These studies have predominantly been conducted at large referral centers specialized in VT ablation and therefore the results may not reflect the general effect of VT ablation due to the selection and high volume in these centers. Therefore, the purpose of this study was to evaluate predictors and use of VT ablation and the post-procedural long-term outcome in a large multicenter cohort of patients with ARVC.…”