Short- and Long-Term Success of Substrate-Based Mapping and Ablation of Ventricular Tachycardia in Arrhythmogenic Right Ventricular Dysplasia

Abstract

Background-Multiple morphologies, hemodynamic instability, or noninducibility may limit ventricular tachycardia (VT) ablation in patients with arrhythmogenic right ventricular dysplasia (ARVD). Substrate-based mapping and ablation may overcome these limitations. We report the results and success of substrate-based VT ablation in ARVD. Methods and Results-Twenty-two patients with ARVD were studied. Traditional mapping for VT was limited because of multiple/changing VT morphologies (nϭ14), nonsustained VT (nϭ10), or hemodynamic intolerance (nϭ5). Sinus rhythm CARTO mapping was performed to define areas of "scar" (Ͻ0.5 mV) and "abnormal" myocardium (0.5 to 1.5 mV). Ablation was performed in "abnormal" regions, targeting sites with good pace maps compared with the induced VT(s). Linear lesions were created in these areas to (1) connect the scar/abnormal region to a valve continuity or other scar or (2) encircle the scar/abnormal region. Eighteen patients had implanted cardioverter defibrillators, 15 had implanted cardioverter defibrillator therapies, and 7 had sustained VT (6 with syncope). VTs (3Ϯ2 per patient) were induced (cycle length, 339Ϯ94 ms), and scar was identified in all patients. Scar areas were related to the tricuspid annulus, proximal right ventricular outflow tract, and anterior/inferior-apical walls. Lesions connected abnormal regions to the annulus (nϭ12) or other scars (nϭ4) and/or encircled abnormal regions (nϭ13). Per patient, a mean of 38Ϯ22 radiofrequency lesions was applied. Short-term success was achieved in 18 patients (82%). VT recurred in 23%, 27%, and 47% of patients after 1, 2, and 3 years' follow-up, respectively. Conclusions-Substrate-based ablation of VT in ARVD can achieve a good short-term success rate. However, recurrences become increasingly common during long-term follow-up. (Circulation. 2005;111:3209-3216.)

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

“…RFA is not a definitive therapy for patients with ARVC [31,46]. 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].…”

“…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]. …”

Almanac 2014: cardiomyopathies

“…Catheter ablation to treat recurrent VT in ARVC has been associated with high recurrence rates [71,72] but a recent multicentre study with focus on newer ablation strategies assessed recurrence of VT following radiofrequency ablation and effect on burden of VT. The authors report a significant reduction in VT burden and longer survival free of VT following epicardial ablation compared with an endocardial procedure.…”

Arrhythmogenic Right Ventricular Cardiomyopathy

“…Deeper and transmural lesion may be obtained by using irrigation catheters with improvement of the ablation success rates. 54,56,59 Several studies investigated acute-and longterm efficacy of catheter ablation of VT in ARVC ( Table 3).…”