Outcomes and ventricular tachycardia recurrence characteristics after epicardial ablation of ventricular tachycardia in arrhythmogenic right ventricular dysplasia/cardiomyopathy

Binu Philips; Anneline S J M te Riele; Abhishek Sawant; Vishnupriya Kareddy; Cynthia A James; Brittney Murray; Crystal Tichnell; Bina Kassamali; Saman Nazarian; Daniel P Judge; Hugh Calkins; Harikrishna Tandri

doi:10.1016/j.hrthm.2014.12.018

Outcomes and ventricular tachycardia recurrence characteristics after epicardial ablation of ventricular tachycardia in arrhythmogenic right ventricular dysplasia/cardiomyopathy

Heart Rhythm. 2015 Apr;12(4):716-25. doi: 10.1016/j.hrthm.2014.12.018. Epub 2014 Dec 18.

Affiliations

¹ Section of Cardiac Electrophysiology, Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island. Electronic address: binu_philips@brown.edu.
² Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
³ Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.

PMID: 25530221
DOI: 10.1016/j.hrthm.2014.12.018

Abstract

Background: Variable success rates have been reported after epicardial radiofrequency catheter ablation (RFA) in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). The details of the electroanatomic substrate are limited to a few studies, and the characteristics of the recurrent ventricular tachycardia (VT) in ARVD/C remain largely unknown.

Objective: The purpose of this study was to report procedural strategy, safety, and efficacy of epicardial RFA at a tertiary single center with a focus on the characteristics of the substrate and recurrent VT.

Methods: We included 30 ARVD/C patients (mean age 33.1 ± 11.1 years, 53% male) who underwent endocardial/epicardial mapping and epicardial catheter ablation of VT at the Johns Hopkins Hospital. Implantable cardioverter-defibrillator interrogations were evaluated for VT recurrence.

Results: The majority of critical VT circuits (69%) were on the epicardial surface, mostly in the subtricuspid region. Eight patients (27%) experienced VT recurrence after epicardial RFA, and the VT-free survival was 83%, 76%, and 70% at 6,12, and 24, months respectively. A significant reduction of VT burden was observed (P <.001), even among those with VT recurrence. No complications occurred except for acute pericarditis in 1 patient. The majority of VT recurrences occurred during the first year after RFA, during exercise, had fast cycle lengths, and required implantable cardioverter-defibrillator shock for termination.

Conclusion: The vast majority of critical VT circuits were epicardial, mostly in the subtricuspid region. Epicardial RFA of VT appears to be both safe and effective in achieving arrhythmia control in ARVD/C. The features of the recurrent VT suggest a possible catecholamine-mediated mechanism with an origin in a region not targeted for ablation.

Keywords: Arrhythmia mechanism; Arrhythmogenic right ventricular dysplasia/cardiomyopathy; Catheter ablation; Ventricular tachycardia.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Arrhythmogenic Right Ventricular Dysplasia / complications*
Catheter Ablation* / adverse effects
Catheter Ablation* / methods
Electrocardiography
Epicardial Mapping / methods
Female
Follow-Up Studies
Humans
Male
Middle Aged
Pericardium / surgery*
Recurrence
Tachycardia, Ventricular* / diagnosis
Tachycardia, Ventricular* / etiology
Tachycardia, Ventricular* / surgery
Treatment Outcome
United States