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Should all patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy undergo epicardial catheter ablation?

Abstract

Background

Epicardial radiofrequency catheter ablation is currently considered as the therapeutic option of choice in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) and recurrent ventricular tachycardia (VT). We hypothesised that inducibility of VT may guide the ablation strategy and thereby affect long-term results. Additional epicardial ablation was only performed if VT were still inducible after thorough endocardial ablation.

Methods

The objective was to examine an inducibility-guided ablation approach by comparing the long-term results between endocardial and epi-endocardial radiofrequency catheter ablation of VT in a large cohort of patients with ARVD/C.

Results

We studied from our ARVD/C registry (70 patients in total, 48 males, age 53.2 ± 14.0) 45 patients (64.3% of all patients) who underwent catheter ablation of VT. All patients received endocardial VT ablation. After endocardial ablation, 24 patients (53.3%) remained inducible. Additional epicardial ablation was performed in 22 patients (48.9%). After ablation, non-inducibility was achieved in overall 38 patients (84.4%). During a mean follow-up of 31.1 ± 27.4 months, 13 patients in each group (59.1% after endo- and epicardial ablation, 56.5% after endocardial ablation) remained free from VT recurrence (P = 0.862).

Conclusions

An inducibility-guided catheter ablation strategy of VT in patients with ARVD/C prevents unnecessary epicardial ablation and may therefore be considered as an alternative to primary combined endo- and epicardial ablation.

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References

  1. 1.

    Marcus FI, McKenna WJ, Sherrill D, Basso C, Bauce B, Bluemke DA, et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the task force criteria. Eur Heart J. 2010;31:806–14.

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Rizzo S, Pilichou K, Thiene G, Basso C. The changing spectrum of arrhythmogenic (right ventricular) cardiomyopathy. Cell Tissue Res. 2012;348:319–23.

    Article  PubMed  Google Scholar 

  3. 3.

    Murray B. Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C): a review of molecular and clinical literature. J Genet Couns. 2012;21:494–504.

    Article  PubMed  Google Scholar 

  4. 4.

    Finocchiaro G, Papadakis M, Robertus JL, Dhutia H, Steriotis AK, Tome M, et al. Etiology of sudden death in sports: insights from a United Kingdom regional registry. J Am Coll Cardiol. 2016;67:2108–15.

    Article  PubMed  Google Scholar 

  5. 5.

    Bhonsale A, James CA, Tichnell C, Murray B, Gagarin D, Philips B, et al. Incidence and predictors of implantable cardioverter-defibrillator therapy in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy undergoing implantable cardioverter-defibrillator implantation for primary prevention. J Am Coll Cardiol. 2011;58:1485–96.

    Article  PubMed  Google Scholar 

  6. 6.

    Arbelo E, Josephson ME. Ablation of ventricular arrhythmias in arrhythmogenic right ventricular dysplasia. J Cardiovasc Electrophysiol. 2010;21:473–86.

    Article  PubMed  Google Scholar 

  7. 7.

    Bai R, Di Biase L, Shivkumar K, Mohanty P, Tung R, Santangeli P, et al. Ablation of ventricular arrhythmias in arrhythmogenic right ventricular dysplasia/cardiomyopathy: arrhythmia-free survival after endo-epicardial substrate based mapping and ablation. Circ Arrhythm Electrophysiol. 2011;4:478–85.

    Article  PubMed  Google Scholar 

  8. 8.

    Philips B, Madhavan S, James C, Tichnell C, Murray B, Dalal D, et al. Outcomes of catheter ablation of ventricular tachycardia in arrhythmogenic right ventricular dysplasia/cardiomyopathy. Circ Arrhythm Electrophysiol. 2012;5:499–505.

    Article  PubMed  Google Scholar 

  9. 9.

    Berruezo A, Fernández-Armenta J, Mont L, Zeljko H, Andreu D, Herczku C, et al. Combined endocardial and epicardial catheter ablation in arrhythmogenic right ventricular dysplasia incorporating scar dechanneling technique. Circ Arrhythm Electrophysiol. 2012;5:111–21.

    Article  PubMed  Google Scholar 

  10. 10.

    Santangeli P, Zado ES, Supple GE, Haqqani HM, Garcia FC, Tschabrunn CM, et al. Long-term outcome with catheter ablation of ventricular tachycardia in patients with arrhythmogenic right ventricular cardiomyopathy. Circ Arrhythm Electrophysiol. 2015;8:1413–21.

    PubMed  Google Scholar 

  11. 11.

    Komatsu Y, Daly M, Sacher F, Cochet H, Denis A, Derval N, et al. Endocardial ablation to eliminate epicardial arrhythmia substrate in scar-related ventricular tachycardia. J Am Coll Cardiol. 2014;63:1416–26.

    Article  PubMed  Google Scholar 

  12. 12.

    Kligfield P, Gettes LS, Bailey JJ, Childers R, Deal BJ, Hancock EW, et al. Recommendations for the standardization and interpretation of the electrocardiogram: part I: the electrocardiogram and its technology a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol. 2007;49:1109–27.

    Article  PubMed  Google Scholar 

  13. 13.

    Sosa E, Scanavacca M, d’Avila A, Oliveira F, Ramires JA. Nonsurgical transthoracic epicardial catheter ablation to treat recurrent ventricular tachycardia occurring late after myocardial infarction. J Am Coll Cardiol. 2000;35:1442–9.

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Müssigbrodt A, Dinov B, Bertagnoli L, Sommer P, Richter S, Breithardt OA, et al. Precordial QRS amplitude ratio predicts long-term outcome after catheter ablation of electrical storm due to ventricular tachycardias in patients with arrhythmogenic right ventricular cardiomyopathy. J Electrocardiol. 2015;48:86–92.

    Article  PubMed  Google Scholar 

  15. 15.

    Arya A, Eitel C, Bollmann A, Wetzel U, Sommer P, Gaspar T, et al. Catheter ablation of scar-related ventricular tachycardia in patients with electrical storm using remote magnetic catheter navigation. Pacing Clin Electrophysiol. 2010;33:1312–8.

    Article  PubMed  Google Scholar 

  16. 16.

    Arya A, Bode K, Piorkowski C, Bollmann A, Sommer P, Gaspar T, et al. Catheter ablation of electrical storm due to monomorphic ventricular tachycardia in patients with nonischemic cardiomyopathy: acute results and its effect on long-term survival. Pacing Clin Electrophysiol. 2010;33:1504–9.

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank all patients for providing their information and all physicians that helped us to obtain follow-up data.

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Corresponding author

Correspondence to Andreas Müssigbrodt.

Ethics declarations

The study was conducted in agreement with the regulations of the institutional ethic committee. All patients provided written informed consent prior to electrophysiological study and catheter ablation. All patients provided written informed consent for data collection and analysis.

Funding sources

None

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Andreas Müssigbrodt and Elena Efimova contributed equally and share first authorship.

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Müssigbrodt, A., Efimova, E., Knopp, H. et al. Should all patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy undergo epicardial catheter ablation?. J Interv Card Electrophysiol 48, 193–199 (2017). https://doi.org/10.1007/s10840-016-0209-3

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Keywords

  • Arrhythmogenic right ventricular dysplasia/cardiomyopathy
  • Radiofrequency
  • Catheter ablation
  • Inducibility
  • Ventricular tachycardia
  • Endocardial
  • Epicardial