title: VT Recurrence After Ablation: Incomplete Ablation or Disease Progression? A Multicentric European Study.
abstract: OBJECTIVE
  To determine whether ventricular tachycardia (VT) recurrences in arrhythmogenic RV cardiomyopathy (ARVC) and nonischemic cardiomyopathy (NICM) are related to incomplete ablation or disease progression.
  
  
  METHODS
  ARVC and NICM patients with two substrate maps of the same diseased ventricle with an interprocedural delay of ≥12 months were included. Disease progression was defined as ≥1 factor: scar area progression (PROG, +5%), ventricular remodeling (dilatation [+25 mL] or decreased ejection fraction [-5%EF]). Incomplete ablation was defined as index VT recurrence or ablation in previously unablated regions inside index scar without PROG.
  
  
  RESULTS
  Twenty patients from nine centers were included (80% male 55 ± 16 years, 7 ARVC and 13 NICM, LVEF 43 ± 14%). Mean delay was 28 ± 18 months. Disease progression occurred in 75% with ventricular remodeling in 70%: ventricular dilation in 45% (ARVC [71%]; NICM [38%]), decreased EF in 60% [RVEF in ARVC (71%); LVEF in NICM (54%)], and scar progression in 50% (in ARVC [57%] and NICM [46%]). Index VT recurrence was observed in 40%. Redo ablation sites were located in previously unablated regions inside the index scar in 70% of patients. VT recurrence following the second procedure was seen in 25%. Fifteen percent died during a follow-up of 17 ± 17 months.
  
  
  CONCLUSIONS
  Disease progression is the rule in ARVC and NICM while scar progression occurs in half. However, even if disease progression is frequently observed, incomplete index ablation is the most common finding, strongly suggesting the need for more extensive ablation.
authors.affiliation: CHU Bordeaux and LIRYC institute, IHU Bordeaux, France.
authors.forename: B
authors.initials: B
authors.lastname: Berte
authors.affiliation: CHU Bordeaux and LIRYC institute, IHU Bordeaux, France.
authors.forename: F
authors.initials: F
authors.lastname: Sacher
authors.affiliation: Leiden University Medical Center, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Venlet
authors.affiliation: Thorax Institute, Hospital Clinic, Barcelona, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Andreu
authors.affiliation: CHU Bordeaux and LIRYC institute, IHU Bordeaux, France.
authors.forename: S
authors.initials: S
authors.lastname: Mahida
authors.affiliation: Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic.
authors.forename: B
authors.initials: B
authors.lastname: Aldhoon
authors.affiliation: OLV Aalst, Belgium.
authors.forename: T
authors.initials: T
authors.lastname: DE Potter
authors.affiliation: UZA Antwerp, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Sarkozy
authors.affiliation: AZ Sint Jan-Bruges, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: Tavernier
authors.affiliation: CHU Nancy, France.
authors.forename: M
authors.initials: M
authors.lastname: Andronache
authors.affiliation: Herz- und Gefäss-Klinik, Bad Neustadt, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Deneke
authors.affiliation: Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Kautzner
authors.affiliation: Thorax Institute, Hospital Clinic, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Berruezo
authors.affiliation: CHU Bordeaux and LIRYC institute, IHU Bordeaux, France.
authors.forename: H
authors.initials: H
authors.lastname: Cochet
authors.affiliation: Leiden University Medical Center, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Zeppenfeld
authors.affiliation: CHU Bordeaux and LIRYC institute, IHU Bordeaux, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
mesh_terms: D000328:Adult; D000368:Aged; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000150:complications; D017115:Catheter Ablation / Q000009:adverse effects*; D002921:Cicatrix / Q000209:etiology / Q000503:physiopathology; D018450:Disease Progression; D022062:Electrophysiologic Techniques, Cardiac; D005060:Europe; D005260:Female; D006329:Heart Conduction System / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology / Q000503:physiopathology; D017380:Hypertrophy, Right Ventricular / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D020257:Ventricular Remodeling
keywords: arrhythmogenic right ventricular cardiomyopathy; catheter ablation; nonischemic cardiomyopathy; substrate map; ventricular tachycardia