title: Outcomes and ventricular tachycardia recurrence characteristics after epicardial ablation of ventricular tachycardia in arrhythmogenic right ventricular dysplasia/cardiomyopathy.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Section of Cardiac Electrophysiology, Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island. Electronic address: binu_philips@brown.edu.
authors.forename: Binu
authors.initials: B
authors.lastname: Philips
authors.affiliation: Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Anneline S J M
authors.initials: AS
authors.lastname: te Riele
authors.affiliation: Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Sawant
authors.affiliation: Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Vishnupriya
authors.initials: V
authors.lastname: Kareddy
authors.affiliation: Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: James
authors.affiliation: Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Brittney
authors.initials: B
authors.lastname: Murray
authors.affiliation: Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Crystal
authors.initials: C
authors.lastname: Tichnell
authors.affiliation: Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Bina
authors.initials: B
authors.lastname: Kassamali
authors.affiliation: Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Saman
authors.initials: S
authors.lastname: Nazarian
authors.affiliation: Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Judge
authors.affiliation: Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.affiliation: Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Harikrishna
authors.initials: H
authors.lastname: Tandri
mesh_terms: D000368:Aged; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000150:complications*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods; D004562:Electrocardiography; D056149:Epicardial Mapping / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000601:surgery*; D012008:Recurrence; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome; D014481:United States
keywords: Arrhythmia mechanism; Arrhythmogenic right ventricular dysplasia/cardiomyopathy; Catheter ablation; Ventricular tachycardia