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Radiofrequency Ablation in Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)

  • Myocardial Disease (A Abbate, Section Editor)
  • Published:
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Abstract

Purpose of Review

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a heritable form of cardiomyopathy, typically with autosomal dominant transmission, shown to be a defect in the cardiac desmosomes, with distinct regional and histopathological features. Clinically, this can ultimately result in bi-ventricular failure and/or malignant ventricular tachycardia (VT) via reentrant circuits created by patchy scar formation. We sought to review the current treatment for ventricular arrhythmias in the setting of ARVC, with particular attention to radiofrequency (RF) ablation and its varied techniques, along with potential therapies in the ablation spectrum.

Recent Findings

There is underwhelming data on the effectiveness of medical therapy for ARVC-related VT, including beta-blockers and antiarrhythmic medication. Primary and secondary prophylactic implantable-cardioverter defibrillator (ICD) implantation in higher-risk patients is recommended. More recently, RF ablation has been used for ARVC-related VT. Endocardial VT ablation in this setting can produce acute success, though recurrence rate is quite high, which may be explained by the more epicardial and patchy nature of the disease. Combined endocardial-epicardial ablation has since been shown to be feasible, safe, and with significantly better acute and long-term success, particularly when combined with scar dechanneling or homogenization of the scar. However, recurrence rates are not insignificant, and ablation does not eliminate the need for ICD placement.

Summary

Medical therapy for ARVC-related VT is suboptimal. RF ablation techniques including endocardial and epicardial approaches appear to have the highest success rates for ARVC-related VT. Catheter ablation of VT in ARVC patients should be considered a potentially effective strategy for eliminating frequent VT episodes and ICD shocks rather than a curative therapeutic approach, until long-term efficacy has been consistently documented. Research into the optimal mapping and ablation techniques are promising and ongoing.

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Authors and Affiliations

  1. Division of Cardiology at Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA

    Jorge Romero, Michael Grushko, David F. Briceño & Luigi Di Biase

  2. Texas Cardiac Arrhythmia Institute, Austin, Texas, USA

    Andrea Natale

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  1. Jorge Romero
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  2. Michael Grushko
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  3. David F. Briceño
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  4. Andrea Natale
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  5. Luigi Di Biase
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Correspondence to Luigi Di Biase.

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Conflict of Interest

Dr. Di Biase is a consultant for Stereotaxis, Biosense Webster, Boston Scientific, and St. Jude Medical and has received speaker honoraria/travel from Medtronic, Janssen, Pfizer, EPiEP, and Biotronik.

Dr. Natale has received speaker honoraria from Boston Scientific, Biosense Webster, St. Jude Medical, Biotronik, and Medtronic and is a consultant for Biosense Webster, St. Jude Medical, and Janssen.

Dr. Romero, Dr. Briceño, and Dr. Grushko declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Myocardial Disease

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Romero, J., Grushko, M., Briceño, D.F. et al. Radiofrequency Ablation in Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC). Curr Cardiol Rep 19, 82 (2017). https://doi.org/10.1007/s11886-017-0893-3

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  • DOI: https://doi.org/10.1007/s11886-017-0893-3

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