title: Ablation of ventricular arrhythmias in arrhythmogenic right ventricular dysplasia/cardiomyopathy: arrhythmia-free survival after endo-epicardial substrate based mapping and ablation.
abstract: BACKGROUND
  In patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy, freedom from ventricular arrhythmias (VAs) after endocardial ablation is limited. We compared the long-term freedom from recurrent VAs by using endocardial-alone ablation versus endo-epicardial substrate-based ablation.
  
  
  RESULTS
  Forty-nine patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy undergoing ablation of ventricular tachycardia (VT) were divided into 2 groups: endocardial-alone ablation (group 1, n = 23) and endo-epicardial ablation (group 2, n = 26). All patients had an implantable cardioverter-defibrillator (ICD). Conventional and 3D mappings were used to determine the mechanism of induced VTs and to identify area of "scar" or "abnormal" myocardium. All critical sites responsible for VTs and points with "abnormal" potential were targeted for ablation from endocardium (group 1) or from both endocardium and epicardium (group 2). The procedural end point was noninducibility of sustained, monomorphic VT with isoproterenol. The presence of frequent premature ventricular contractions at the end of ablation was recorded. Patients were followed up by ECG, Holter, and ICD interrogation. After a follow-up of at least 3 years, freedom from VAs or ICD therapy was 52.2% (12/23) in group 1 and 84.6% (22/26) in group 2 (P = 0.029), with 21.7% (5/23) and 69.2% (18/26) patients off antiarrhythmic drugs (P < 0.001), respectively. Compared with patients with no premature ventricular contractions after ablation, patients with frequent premature ventricular contractions after ablation were more likely to have VA recurrence/ICD therapy [3/33 (9%) versus 12/16 (75%); log-rank P<0.001].
  
  
  CONCLUSIONS
  An endo-epicardial-based ablation strategy achieves higher long-term freedom from recurrent VAs off antiarrhythmic therapy in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy when compared with endocardial-alone ablation. The presence of ≥ 10 premature ventricular contractions per minute after ablation is associated with more VA recurrence.
authors.affiliation: Texas Cardiac Arrhythmia Institute at St David's Medical Center, Austin, TX, USA.
authors.forename: Rong
authors.initials: R
authors.lastname: Bai
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.forename: Kalyanam
authors.initials: K
authors.lastname: Shivkumar
authors.forename: Prasant
authors.initials: P
authors.lastname: Mohanty
authors.forename: Roderick
authors.initials: R
authors.lastname: Tung
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.forename: Luis Carlos
authors.initials: LC
authors.lastname: Saenz
authors.forename: Miguel
authors.initials: M
authors.lastname: Vacca
authors.forename: Atul
authors.initials: A
authors.lastname: Verma
authors.forename: Yariv
authors.initials: Y
authors.lastname: Khaykin
authors.forename: Sanghamitra
authors.initials: S
authors.lastname: Mohanty
authors.forename: J David
authors.initials: JD
authors.lastname: Burkhardt
authors.forename: Richard
authors.initials: R
authors.lastname: Hongo
authors.forename: Salwa
authors.initials: S
authors.lastname: Beheiry
authors.forename: Antonio
authors.initials: A
authors.lastname: Dello Russo
authors.forename: Michela
authors.initials: M
authors.lastname: Casella
authors.forename: Gemma
authors.initials: G
authors.lastname: Pelargonio
authors.forename: Pietro
authors.initials: P
authors.lastname: Santarelli
authors.forename: Javier
authors.initials: J
authors.lastname: Sanchez
authors.forename: Claudio
authors.initials: C
authors.lastname: Tondo
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D000328:Adult; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000150:complications* / Q000628:therapy; D017115:Catheter Ablation / Q000379:methods*; D017147:Defibrillators, Implantable; D018572:Disease-Free Survival; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D004699:Endocardium / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000601:surgery*; D011446:Prospective Studies; D012008:Recurrence; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome