title: Long-Term Outcome With Catheter Ablation of Ventricular Tachycardia in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy.
abstract: BACKGROUND
  Catheter ablation of ventricular tachycardia (VT) in arrhythmogenic right ventricular cardiomyopathy improves short-term VT-free survival. We sought to determine the long-term outcomes of VT control and need for antiarrhythmic drug therapy after endocardial (ENDO) and adjuvant epicardial (EPI) substrate modification in patients with arrhythmogenic right ventricular cardiomyopathy.
  
  
  RESULTS
  We examined 62 consecutive patients with Task Force criteria for arrhythmogenic right ventricular cardiomyopathy referred for VT ablation with a minimum follow-up of 1 year. Catheter ablation was guided by activation/entrainment mapping for tolerated VT and pacemapping/targeting of abnormal substrate for unmappable VT. Adjuvant EPI ablation was performed when recurrent VT or persistent inducibility after ENDO-only ablation. Endocardial plus adjuvant EPI ablation was performed in 39 (63%) patients, including 13 who crossed over to ENDO-EPI after VT recurrence during follow-up, after ENDO-only ablation. Before ablation, 54 of 62 patients failed a mean of 2.4 antiarrhythmic drugs, including amiodarone in 29 (47%) patients. During follow-up of 56±44 months after the last ablation, VT-free survival was 71% with only a single VT episode in additional 9 patients (15%). At last follow-up, 39 (64%) patients were only on β-blockers or no treatment, 21 were on class 1 or 3 antiarrhythmic drugs (11 for atrial arrhythmias), and 2 were on amiodarone as a bridge to heart transplantation.
  
  
  CONCLUSIONS
  The long-term outcome after ENDO and adjuvant EPI substrate ablation of VT in arrhythmogenic right ventricular cardiomyopathy is good. Most patients have complete VT control without amiodarone therapy and limited need for antiarrhythmic drugs.
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Erica S
authors.initials: ES
authors.lastname: Zado
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Supple
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Haris M
authors.initials: HM
authors.lastname: Haqqani
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Fermin C
authors.initials: FC
authors.lastname: Garcia
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Cory M
authors.initials: CM
authors.lastname: Tschabrunn
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: David J
authors.initials: DJ
authors.lastname: Callans
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: David
authors.initials: D
authors.lastname: Lin
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dixit
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Mathew D
authors.initials: MD
authors.lastname: Hutchinson
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Riley
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia. francis.marchlinski@uphs.upenn.edu.
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
mesh_terms: D000200:Action Potentials; D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation / Q000009:adverse effects; D016208:Databases, Factual; D018572:Disease-Free Survival; D004699:Endocardium / Q000503:physiopathology / Q000601:surgery*; D056149:Epicardial Mapping; D005260:Female; D006339:Heart Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000503:physiopathology / Q000601:surgery*; D015143:Philadelphia; D016016:Proportional Hazards Models; D012008:Recurrence; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: ablation techniques; antiarrhythmic drugs; arrhythmogenic right ventricular dysplasia; catheter ablation; tachycardia, ventricular