title: Outcomes of catheter ablation of ventricular tachycardia in arrhythmogenic right ventricular dysplasia/cardiomyopathy.
abstract: BACKGROUND
  Prior studies evaluating the efficacy of catheter ablation of ventricular tachycardia (VT) among patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) have reported varied outcomes. More recently, studies have suggested that an epicardial ablation is necessary for improved outcomes after catheter ablation of VT. The overall objective of the present study was to assess the efficacy of radiofrequency catheter ablation (RFA) of VT in ARVD/C, with particular focus on newer ablation strategies, including epicardial catheter ablation.
  
  
  RESULTS
  The study population included 87 patients with ARVD/C who underwent a total of 175 RFA procedures between 1992 and 2011 at 80 different electrophysiology centers. Recurrence of VT following RFA and effect of RFA on the burden of VT were assessed. The mean age of the cohort was 38±13 years. Over a mean follow-up of 88.3±66 months, the overall freedom from VT of the 175 procedures was 47%, 21%, and 15%, at 1, 5, and 10 years, respectively. The cumulative freedom from VT following epicardial RFA was 64% and 45% at 1 and 5 years, respectively, which was significantly longer than endocardial RFA (P=0.021). Survival free of VT among procedures with 3D electroanatomic mapping was significantly longer compared to those without (P=0.016). Burden of VT was reduced irrespective of the ablation strategy (P<0.001).
  
  
  CONCLUSIONS
  Although VT recurrences are common, RFA results in a significant reduction in the burden of VT in patients with ARVD/C. Further, although the use of 3D electroanatomic mapping systems and epicardial ablation strategies are associated with longer survival free of VT, recurrence rates remain considerable.
authors.affiliation: Division of Cardiology, Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
authors.forename: Binu
authors.initials: B
authors.lastname: Philips
authors.forename: Srinivasa
authors.initials: S
authors.lastname: Madhavan
authors.forename: Cynthia
authors.initials: C
authors.lastname: James
authors.forename: Crystal
authors.initials: C
authors.lastname: Tichnell
authors.forename: Brittney
authors.initials: B
authors.lastname: Murray
authors.forename: Darshan
authors.initials: D
authors.lastname: Dalal
authors.forename: Aditya
authors.initials: A
authors.lastname: Bhonsale
authors.forename: Saman
authors.initials: S
authors.lastname: Nazarian
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Judge
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Russell
authors.forename: Theodore
authors.initials: T
authors.lastname: Abraham
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.forename: Harikrishna
authors.initials: H
authors.lastname: Tandri
mesh_terms: D000328:Adult; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D004699:Endocardium / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D008297:Male; D011446:Prospective Studies; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome