Long-Term Efficacy of Catheter Ablation of Ventricular Tachycardia in Patients With Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy

Dalal, Darshan; Jain, Rahul; Tandri, Harikrishna; Dong, Jun; Eid, Shaker M.; Prakasa, Kalpana; Tichnell, Crystal; James, Cynthia A.; Abraham, Theodore P.; Russell, Stuart D.; Sinha, Sunil K.; Judge, Daniel P.; Bluemke, David A.; Marine, Joseph E.; Calkins, Hugh

doi:10.1016/j.jacc.2007.03.049

Cited by 229 publications

(144 citation statements)

References 44 publications

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“…5,6) The pros and cons of the efficacy of RFCA with electroanatomic mapping to suppress VT were also reported. [19][20][21] We used electroanatomic mapping techniques in one patient to suppress frequent VT recurrence after RFCA and ICD therapies. We consider the efficacy of the electroanatomic mapping technique to be controversial.…”

Section: Discussionmentioning

confidence: 99%

Clinical Course of Arrhythmogenic Right Ventricular Cardiomyopathy in the Era of Implantable Cardioverter-Defibrillators and Radiofrequency Catheter Ablation

et al. 2010

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SummaryThis study investigated the clinical course of arrhythmogenic right ventricular cardiomyopathy (ARVC) patients and in particular evaluated the contribution of radiofrequency catheter ablation (RFCA) and an implantable cardioverter-defibrillator (ICD) to the treatment of ARVC.ARVC is a myocardial disorder and a cause of sudden cardiac death due to ventricular tachycardia (VT). Little is known about its prognosis in Japanese ARVC patients.Thirty-five ARVC patients were studied. Mean age of patients whose onset of ARVC was congestive heart failure (CHF) (66.0 ± 4.0 years) was significantly higher than those whose onset was VT (44.5 ± 14.8 years, P < 0.05). ARVC patients with CHF onset showed significantly higher death rates compared to those with VT onset. ICD treatment significantly reduced episodes of hospitalization due to VT (0.1 ± 0.4 episodes) in comparison to treatment by RFCA (1.7 ± 2.2 episodes, P < 0.03). RFCA treatment did not reduce recurrence of VT in the followup period. ICD therapy showed comparable mortality to RFCA treatment.The prognosis of ARVC with CHF onset is poor. ICD therapy significantly reduced hospitalization due to VT compared with RFCA treatment. ICD implantation in combination with medication may be a better treatment for ARVC. (Int Heart J 2010; 51: 34-40)

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Section: Discussionmentioning

confidence: 99%

Clinical Course of Arrhythmogenic Right Ventricular Cardiomyopathy in the Era of Implantable Cardioverter-Defibrillators and Radiofrequency Catheter Ablation

et al. 2010

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“…However, RFA can be considered as an adjuvant therapy to ICD placement in patients with VT or frequent ICD firing despite using BB or antiarrhythmic drugs or in patients who were not able to tolerate ARVC recommended medications (class I) [22]. Furthermore, multiple electrophysiologic mapping techniques have been used to treat VA including voltage mapping and substrate mapping [31,32,46–48]. …”

Section: Radiofrequency Ablationmentioning

confidence: 99%

“…Combined endocardial–epicardial VT ablation has had significant short- and long-term success rates compared to endocardial VT ablation alone [22,49]. VT recurrence following VT ablation could be explained by the patchy nature of ARVC; hence, development of new arrhythmic foci is not infrequent [32,50,51]. Therefore, RFA is currently not recommended as stand-alone therapy or as an alternative to ICD for ARVC patients due the progressive nature of ARVC (class III) [22].…”

Section: Radiofrequency Ablationmentioning

confidence: 99%

Right ventricular dysplasia: management and treatment in light of current evidence

Idris

Shah

Park

2018

Journal of Community Hospital Internal Medicine Perspectives

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Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare cardiovascular disease that predisposes to ventricular arrhythmias potentially leading to sudden cardiac death (SCD). ARVC varies considerably with multiple clinical presentations, ranging from no symptoms to cardiac arrhythmias to SCD. ARVC prevalence is not well known, but the estimated prevalence in the general population is 1:5000. Diagnosis of ARVC can be made by using the Revised European Society of Cardiology criteria for ARVC that includes ventricular structural and functional changes, ECG abnormalities, arrhythmias, family and genetic factors. The management of ARVC is focused on prevention of lethal events such as SCD. Implantable cardioverter defibrillator placement is the only proven mortality benefit in treatment of ARVC. Other treatment strategies include medications such as beta blockers and antiarrhythmics, radiofrequency ablation, surgery, cardiac transplantation, and lifestyle changes. All these interventions help in symptomatic treatment but none of them have proved to decrease mortality rates. ARVC is a progressive disease that leads to SCD if not treated appropriately. Management of these diseases has been a challenge for physicians. With the advent of technology and many new drugs/devices under clinical investigation, this might change in the future. However, while advances in technologies have helped elucidate many aspects of these diseases, many mysteries still remain of this unique disease. With continued research, we can expect more cost-effective and patient-friendly drug therapies and ablation techniques to be developed in the near future.

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“…Although recent technological advances with electroanatomic and voltage mapping systems have significantly improved outcomes [27][28], catheter ablation can reduce the frequency of VT episodes, but long-term follow-up studies have demonstrated a risk of recurrence. However, only an endocardial approach was used in most of the cases previously reported [29][30][31].…”

Section: Arrhythmogenic Right Ventricular Cardiomyopathymentioning

confidence: 99%

Long‐term outcomes of catheter ablation of ventricular tachycardia in patients with structural heart disease

Goya

Fukunaga

Hiroshima

et al. 2014

Journal of Arrhythmia

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a b s t r a c tBackground: Catheter ablation of ventricular tachycardia (VT) is feasible. However, the long-term outcomes for different underlying diseases have not been well defined. Methods: Eighty-eight consecutive patients who underwent catheter ablation of VT using a threedimensional mapping system were analyzed. The primary endpoint was any VT or ventricular fibrillation (VF) recurrence. Secondary endpoints were a composite of death or any VT/VF recurrence. Underlying heart diseases were remote myocardial infarction (remote MI) in 51 patients and non-ischemic cardiomyopathy in 37 (arrhythmogenic right ventricular cardiomyopathy [ARVC] in 18 patients, and dilated cardiomyopathy [NIDCM] in 19). Results: Acute success was achieved in 82 of 88 (93%) patients. During a follow-up period of 39.2 74.6 months, VT recurred in 26 of 87 (30%), and VT/VF recurrence or death occurred in 39 of 87 (45%) patients. ARVC had better outcomes than NIDCM for the primary (p o 0.05) and secondary endpoints (po 0.05). Remote MI-VT revealed a midrange outcome. Conclusions: The long-term outcomes after catheter ablation of VT varied according to the underlying heart disease. ARVC-VT ablation was associated with better long-term prognosis than NIDCM. Remote MI-VT demonstrated a midrange outcome.

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Long-Term Efficacy of Catheter Ablation of Ventricular Tachycardia in Patients With Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy

Abstract: Our study shows a high rate of recurrence in ARVD/C patients undergoing RFA of VT. This likely reflects the fact that ARVD/C is a diffuse cardiomyopathy with progressively evolving electrical substrate. Further studies are needed to define the precise role of RFA of VT in ARVD/C.

Cited by 229 publications

References 44 publications

Clinical Course of Arrhythmogenic Right Ventricular Cardiomyopathy in the Era of Implantable Cardioverter-Defibrillators and Radiofrequency Catheter Ablation

Clinical Course of Arrhythmogenic Right Ventricular Cardiomyopathy in the Era of Implantable Cardioverter-Defibrillators and Radiofrequency Catheter Ablation

Right ventricular dysplasia: management and treatment in light of current evidence

Long‐term outcomes of catheter ablation of ventricular tachycardia in patients with structural heart disease

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