TY - JOUR
T1 - Catheter Ablation of Ventricular Tachycardia in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: A Sequential Approach
AU - Mathew, Shibu
AU - Saguner, Ardan M.
AU - Schenker, Niklas
AU - Kaiser, Lukas
AU - Zhang, Pengpai
AU - Yashuiro, Yoshiga
AU - Lemes, Christine
AU - Fink, Thomas
AU - Maurer, Tilman
AU - Santoro, Francesco
AU - Wohlmuth, Peter
AU - Reißmann, Bruno
AU - Heeger, Christian H.
AU - Tilz, Roland
AU - Wissner, Erik
AU - Rillig, Andreas
AU - Metzner, Andreas
AU - Kuck, Karl Heinz
AU - Ouyang, Feifan
N1 - Funding Information:
Dr Kuck reports grants and personal fees from St. Jude Medical, Biosense Webster, and Medtronic, outside the submitted work. Dr Saguner reports educational grants from Biosense Webster. Dr. Mathew received travel grants and personal fees from Biosense Webster and Medtronic. Dr Rillig received travel grants from Biosense Webster, and St. Jude Medical and lecture fees from St. Jude Medical and Boehringer Ingelheim and took part at the Boston scientific electrophysiological fellowship. Dr Tilz reports grants, personal fees, and nonfinancial support from Biosense Webster, personal fees and nonfinancial support from St. Jude medical, nonfinancial support from Abbott, outside the submitted work. The remaining authors have no disclosures to report.
Publisher Copyright:
© 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/3/5
Y1 - 2019/3/5
N2 - Background: It has been suggested that endocardial and epicardial ablation of ventricular tachycardia (VT) improves outcome in arrhythmogenic right ventricular cardiomyopathy/dysplasia. We investigated our sequential approach for VT ablation in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia in a single center. Methods and Results: We included 47 patients (44±16 years) with definite (81%) or borderline (19%) arrhythmogenic right ventricular cardiomyopathy/dysplasia between 1998 and 2016. Our ablation strategy was to target the endocardial substrate. Epicardial ablation was performed in case of acute ablation failure or lack of an endocardial substrate. Single and multiple procedural 1- and 5-year outcome data for the first occurrence of the study end points (sustained VT/ventricular fibrillation, heart transplant, and death after the index procedure, and sustained VT/ventricular fibrillation for multiple procedures) are reported. Eighty-one radiofrequency ablation procedures were performed (mean 1.7 per patient, range 1–4). Forty-five (56%) ablation procedures were performed via an endocardial, 11 (13%) via an epicardial, and 25 (31%) via a combined endo- and epicardial approach. Complete acute success was achieved in 65 (80%) procedures, and partial success in 13 (16%). After a median follow-up of 50.8 (interquartile range, [18.6; 99.2]) months after the index procedure, 17 (36%) patients were free from the primary end point. After multiple procedures, freedom from sustained VT/ventricular fibrillation was 63% (95% CI, 52–75) at 1 year, and 45% (95% CI, 34–61) at 5 years, with 36% of patients receiving only endocardial radiofrequency ablation. A trend (log rank P=0.058) towards an improved outcome using a combined endo-/epicardial approach was observed after multiple procedures. Conclusion: Endocardial ablation can be effective in a considerable number of arrhythmogenic right ventricular cardiomyopathy/dysplasia patients with VT, potentially obviating the need for an epicardial approach.
AB - Background: It has been suggested that endocardial and epicardial ablation of ventricular tachycardia (VT) improves outcome in arrhythmogenic right ventricular cardiomyopathy/dysplasia. We investigated our sequential approach for VT ablation in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia in a single center. Methods and Results: We included 47 patients (44±16 years) with definite (81%) or borderline (19%) arrhythmogenic right ventricular cardiomyopathy/dysplasia between 1998 and 2016. Our ablation strategy was to target the endocardial substrate. Epicardial ablation was performed in case of acute ablation failure or lack of an endocardial substrate. Single and multiple procedural 1- and 5-year outcome data for the first occurrence of the study end points (sustained VT/ventricular fibrillation, heart transplant, and death after the index procedure, and sustained VT/ventricular fibrillation for multiple procedures) are reported. Eighty-one radiofrequency ablation procedures were performed (mean 1.7 per patient, range 1–4). Forty-five (56%) ablation procedures were performed via an endocardial, 11 (13%) via an epicardial, and 25 (31%) via a combined endo- and epicardial approach. Complete acute success was achieved in 65 (80%) procedures, and partial success in 13 (16%). After a median follow-up of 50.8 (interquartile range, [18.6; 99.2]) months after the index procedure, 17 (36%) patients were free from the primary end point. After multiple procedures, freedom from sustained VT/ventricular fibrillation was 63% (95% CI, 52–75) at 1 year, and 45% (95% CI, 34–61) at 5 years, with 36% of patients receiving only endocardial radiofrequency ablation. A trend (log rank P=0.058) towards an improved outcome using a combined endo-/epicardial approach was observed after multiple procedures. Conclusion: Endocardial ablation can be effective in a considerable number of arrhythmogenic right ventricular cardiomyopathy/dysplasia patients with VT, potentially obviating the need for an epicardial approach.
UR - http://www.scopus.com/inward/record.url?scp=85062429209&partnerID=8YFLogxK
U2 - 10.1161/JAHA.118.010365
DO - 10.1161/JAHA.118.010365
M3 - Journal articles
C2 - 30813830
AN - SCOPUS:85062429209
SN - 2047-9980
VL - 8
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 5
M1 - e010365
ER -
