Ventricular tachycardia catheter ablation in arrhythmogenic right ventricular dysplasia: A 16-year experience
- 88 Downloads
Arrhythmogenic right ventricular dysplasia (ARVD) is a structural heart disease affecting young adults that leads to cardiac rhythm disorders including supraventricular and mostly ventricular arrhythmias. Sudden death may be the first presentation of the disease. Ablation techniques have been used for the treatment of ventricular tachycardia in cases resistant to drug therapy. Radiofrequency is appropriate as a first approach for ventricular tachycardia ablation in ARVD; however, its effectiveness is less than 40% at the first session. Fulguration is effective for ventricular tachycardia ablation and should be used in the same session after ineffective radiofrequency ablation. However, fulguration requires expertise, general anesthesia, and more than one session in half of all patients.
Radiofrequency and fulguration plus other common forms of treatment including pacemakers and automatic implantable cardioverter defibrillators provides a clinical success rate of 81% to 93% in a series of 50 consecutive patients studied during 16 years. Earlier poor reputation of fulguration was the result of poorly understood technical problems concerning the physics and biophysics of the procedure under control with presently available methods. This in-depth study of a large population over a long time period demonstrates that fulguration should be rehabilitated.
KeywordsVentricular Tachycardia Right Ventricle Catheter Ablation Structural Heart Disease Clinical Success Rate
Unable to display preview. Download preview PDF.
References and Recommended Reading
- 5.Borggrefe M, Willems S, Chen X, et al.: Catheter ablation of ventricular tachycardia using radiofrequency current. Hertz 1992, 17:171–178.Google Scholar
- 7.Tonet J, Himbert C, Johnson N, et al.: Prolongation of ventricular refractoriness and ventricular tachycardia cycle length by the combination of oral beta-blocker-amiodarone in patients with Ventricular Tachycardia. PACE 2000, 23(Part II):565. Demonstration of the benefit of Amiodarone in combination with b-blocking agents. However this combination may lead in 15% of cases to dynamic drug to drug interaction necessitating rate support pacemaker implantation.Google Scholar
- 9.Fontaine G, Cansell A, Lampe L, et al.: Endocavitary fulguration (electrode catheter ablation): equipment-related problems. In Ablation in Cardiac Arrhythmias. Edited by G Fontaine, MM Scheiman. Mount Kisko: Futura; 1987:85–100.Google Scholar
- 10.Gallais Y, Lascault G, Tonet J, et al.: Continuous measurement of coronary sinus oxygen saturation during ventricular tachycardia [Abstract]. Eur Heart J 1993, 14(supp.): 368.Google Scholar
- 12.Fontaine G, Frank R, Tonet J, et al.: Identification of a zone of slow conduction appropriate for VT ablation: theoreticaland practical considerations. PACE 1989, 12(Part II):262- 267.Google Scholar
- 23.Wichter T, Hindricks G, Kottkamp H, et al.: Catheter ablation of ventricular tachycardia. In Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia. Edited by Nava A, Rossi L, Thiene G. Amsterdam: Elsevier Science; 1997:376–391.Google Scholar
- 24.Stevenson WG, Delacretaz E, Friedman PL, et al.: Identification and ablation of macro-reentrant ventricular tachycardia with the CARTO electroanatomical mapping system. PACE 1998, 21:1448–1456. Description of a new promising technique for proper localization of catheter inside the heart for VT ablation.PubMedGoogle Scholar