title: Should all patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy undergo epicardial catheter ablation?
abstract: BACKGROUND
  Epicardial radiofrequency catheter ablation is currently considered as the therapeutic option of choice in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) and recurrent ventricular tachycardia (VT). We hypothesised that inducibility of VT may guide the ablation strategy and thereby affect long-term results. Additional epicardial ablation was only performed if VT were still inducible after thorough endocardial ablation.
  
  
  METHODS
  The objective was to examine an inducibility-guided ablation approach by comparing the long-term results between endocardial and epi-endocardial radiofrequency catheter ablation of VT in a large cohort of patients with ARVD/C.
  
  
  RESULTS
  We studied from our ARVD/C registry (70 patients in total, 48 males, age 53.2 ± 14.0) 45 patients (64.3% of all patients) who underwent catheter ablation of VT. All patients received endocardial VT ablation. After endocardial ablation, 24 patients (53.3%) remained inducible. Additional epicardial ablation was performed in 22 patients (48.9%). After ablation, non-inducibility was achieved in overall 38 patients (84.4%). During a mean follow-up of 31.1 ± 27.4 months, 13 patients in each group (59.1% after endo- and epicardial ablation, 56.5% after endocardial ablation) remained free from VT recurrence (P = 0.862).
  
  
  CONCLUSIONS
  An inducibility-guided catheter ablation strategy of VT in patients with ARVD/C prevents unnecessary epicardial ablation and may therefore be considered as an alternative to primary combined endo- and epicardial ablation.
authors.affiliation: Department of Electrophysiology, Heart Centre, University of Leipzig, Strümpellstrasse 39, 04289, Leipzig, Germany. andreas.muessigbrodt@gmail.com.
authors.forename: Andreas
authors.identifier: http://orcid.org/0000-0003-0748-0302
authors.initials: A
authors.lastname: Müssigbrodt
authors.affiliation: Department of Electrophysiology, Heart Centre, University of Leipzig, Strümpellstrasse 39, 04289, Leipzig, Germany.
authors.forename: Elena
authors.initials: E
authors.lastname: Efimova
authors.affiliation: Department of Electrophysiology, Heart Centre, University of Leipzig, Strümpellstrasse 39, 04289, Leipzig, Germany.
authors.forename: Helge
authors.initials: H
authors.lastname: Knopp
authors.affiliation: Department of Electrophysiology, Heart Centre, University of Leipzig, Strümpellstrasse 39, 04289, Leipzig, Germany.
authors.forename: Livio
authors.initials: L
authors.lastname: Bertagnolli
authors.affiliation: Department of Electrophysiology, Heart Centre, University of Leipzig, Strümpellstrasse 39, 04289, Leipzig, Germany.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Dagres
authors.affiliation: Department of Electrophysiology, Heart Centre, University of Leipzig, Strümpellstrasse 39, 04289, Leipzig, Germany.
authors.forename: Sergio
authors.initials: S
authors.lastname: Richter
authors.affiliation: Department of Electrophysiology, Heart Centre, University of Leipzig, Strümpellstrasse 39, 04289, Leipzig, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Husser
authors.affiliation: Department of Electrophysiology, Heart Centre, University of Leipzig, Strümpellstrasse 39, 04289, Leipzig, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Bollmann
authors.affiliation: Department of Electrophysiology, Heart Centre, University of Leipzig, Strümpellstrasse 39, 04289, Leipzig, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
authors.affiliation: Department of Electrophysiology, Heart Centre, University of Leipzig, Strümpellstrasse 39, 04289, Leipzig, Germany.
authors.forename: Arash
authors.initials: A
authors.lastname: Arya
mesh_terms: D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods / Q000706:statistics & numerical data*; D015897:Comorbidity; D005858:Germany / Q000453:epidemiology; D006329:Heart Conduction System / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010496:Pericardium / Q000601:surgery*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D016896:Treatment Outcome
keywords: Arrhythmogenic right ventricular dysplasia/cardiomyopathy; Catheter ablation; Endocardial; Epicardial; Inducibility; Radiofrequency; Ventricular tachycardia