Long-term efficacy of catheter ablation of ventricular tachycardia in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy.
OBJECTIVE
This study sought to evaluate the outcomes of radiofrequency catheter ablation (RFA) of ventricular tachycardia (VT) in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) patients. Particular focus was placed on defining the single-procedure efficacy over long-term follow-up.


BACKGROUND
ARVD/C is an inherited cardiomyopathy characterized by VT and right ventricular dysfunction. Prior single-center studies have reported conflicting results concerning the efficacy of RFA of VT in ARVD/C patients.


METHODS
The study population comprised 24 patients (age 36 +/- 9 years, 11 male), enrolled in the Johns Hopkins ARVD registry, who underwent 1 or more RFA procedures for treatment of VT. Patients were followed up for 32 +/- 36 months (range 1 day to 12 years). Recurrence was defined as the documentation of VT subsequent to the procedure.


RESULTS
A total of 48 RFA procedures were performed using 3-dimensional electroanatomical (n = 10) or conventional (n = 38) mapping. Of these procedures, 22 (46%), 15 (31%), and 11 (23%) resulted in elimination of all inducible VTs, clinical VT but not all, and none of the inducible VTs, respectively. Forty (85%) procedures were followed by recurrence. The cumulative VT recurrence-free survival was 75%, 50%, and 25% after 1.5, 5, and 14 months, respectively. The cumulative VT recurrence-free survival did not differ by procedural success, mapping technique, or repetition of procedures. There was 1 procedure-related death.


CONCLUSIONS
Our study shows a high rate of recurrence in ARVD/C patients undergoing RFA of VT. This likely reflects the fact that ARVD/C is a diffuse cardiomyopathy with progressively evolving electrical substrate. Further studies are needed to define the precise role of RFA of VT in ARVD/C.
Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Darshan
D
Dalal
Rahul
R
Jain
Harikrishna
H
Tandri
Jun
J
Dong
Shaker M
SM
Eid
Kalpana
K
Prakasa
Crystal
C
Tichnell
Cynthia
C
James
Theodore
T
Abraham
Stuart D
SD
Russell
Sunil
S
Sinha
Daniel P
DP
Judge
David A
DA
Bluemke
Joseph E
JE
Marine
Hugh
H
Calkins
D000328:Adult; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D015142:Baltimore / Q000453:epidemiology; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016019:Survival Analysis; D013995:Time; D016896:Treatment Outcome