Short- and long-term success of substrate-based mapping and ablation of ventricular tachycardia in arrhythmogenic right ventricular dysplasia.
BACKGROUND
Multiple morphologies, hemodynamic instability, or noninducibility may limit ventricular tachycardia (VT) ablation in patients with arrhythmogenic right ventricular dysplasia (ARVD). Substrate-based mapping and ablation may overcome these limitations. We report the results and success of substrate-based VT ablation in ARVD.


RESULTS
Twenty-two patients with ARVD were studied. Traditional mapping for VT was limited because of multiple/changing VT morphologies (n=14), nonsustained VT (n=10), or hemodynamic intolerance (n=5). Sinus rhythm CARTO mapping was performed to define areas of "scar" (<0.5 mV) and "abnormal" myocardium (0.5 to 1.5 mV). Ablation was performed in "abnormal" regions, targeting sites with good pace maps compared with the induced VT(s). Linear lesions were created in these areas to (1) connect the scar/abnormal region to a valve continuity or other scar or (2) encircle the scar/abnormal region. Eighteen patients had implanted cardioverter defibrillators, 15 had implanted cardioverter defibrillator therapies, and 7 had sustained VT (6 with syncope). VTs (3+/-2 per patient) were induced (cycle length, 339+/-94 ms), and scar was identified in all patients. Scar areas were related to the tricuspid annulus, proximal right ventricular outflow tract, and anterior/inferior-apical walls. Lesions connected abnormal regions to the annulus (n=12) or other scars (n=4) and/or encircled abnormal regions (n=13). Per patient, a mean of 38+/-22 radiofrequency lesions was applied. Short-term success was achieved in 18 patients (82%). VT recurred in 23%, 27%, and 47% of patients after 1, 2, and 3 years' follow-up, respectively.


CONCLUSIONS
Substrate-based ablation of VT in ARVD can achieve a good short-term success rate. However, recurrences become increasingly common during long-term follow-up.
Verma
Atul
A
Section of Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Kilicaslan
Fethi
F
Schweikert
Robert A
RA
Tomassoni
Gery
G
Rossillo
Antonio
A
Marrouche
Nassir F
NF
Ozduran
Volkan
V
Wazni
Oussama M
OM
Elayi
Samy C
SC
Saenz
Luis C
LC
Minor
Stephen
S
Cummings
Jennifer E
JE
Burkhardt
J David
JD
Hao
Steven
S
Beheiry
Salwa
S
Tchou
Patrick J
PJ
Natale
Andrea
A
D000328:Adult; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome