Long-Term Outcomes of Radio-Frequency Catheter Ablation on Ventricular Tachycardias Due to Arrhythmogenic Right Ventricular Cardiomyopathy: A Single Center Experience

<div><p>Aims</p><p>To summarize our experience of radiofrequency catheter ablation (RFCA) for recurrent drug-refractory ventricular tachycardias (VTs) due to arrhythmogenic right ventricular cardiomyopathy (ARVC) in our center over the past 11 years and its related factors.</p><p>Methods and Results</p><p>We reviewed 48 adults (mean age 39.9 ± 12.9 years, range: 14 to 65) who met the present ARVC diagnostic criteria and accepted RFCA for VTs from December 2004 to April 2016. The patients received a total of 70 procedures using two ablation approaches, the endocardial approach in 52 RFCAs, and the combined epicardial and endocardial approach (the combined approach) in 18 RFCAs. Kaplan-Meier survival analysis showed that the combined approach achieved better acute procedural success (<i>p</i> = 0.003) and better long-term outcomes (<i>p</i> = 0.028) than the endocardial approach. Patients who obtained acute procedural success with non-inducibility had better long-term outcomes (<i>p</i> < 0.001). COX regression of multivariate analysis showed that procedural success was the only factor that benefited long-term outcome, irrespective of the endocardial or the combined approach (<i>p</i> = 0.001). The rate of sudden cardiac death (SCD) in patients without procedural success was significantly higher than that in patients with procedural success (<i>p</i> = 0.005). All patients without implantable cardioverter defibrillator (ICD) implantation who had successful final RFCA survived.</p><p>Conclusions</p><p>The combined approach resulted in better procedural success and long-term VT-free survival compared with the endocardial approach in ARVC patients with recurrent VTs. Acute procedural success with non-inducibility was strongly related to better long-term VT-free survival and reduced SCD, irrespective of whether this was achieved by the endocardial approach or the combined approach.</p></div

The overall cumulative VT-free survival curve of all 70 procedures.

<p>The overall cumulative VT-free survival curve of all 70 procedures.</p

Multivariate analysis of VT-free survival in the endocardial approach group by COX regression analysis.

<p>Multivariate analysis of VT-free survival in the endocardial approach group by COX regression analysis.</p

Multivariate analysis of VT-free survival in all patients by COX regression analysis.

<p>Multivariate analysis of VT-free survival in all patients by COX regression analysis.</p

General demographic data and clinical status.

<p>General demographic data and clinical status.</p

This series of pictures show the electrophysiological characteristics in the RV epicardium of an ARVC patient.

<p>(A) A concealed entrainment within the isthmus of the reentrant circuit. The post-pacing interval (PPI) was 320 ms, almost equal to the VT cycle length (326 ms). The interval between the stimulation signal to onset of QRS complex (S-QRS) was 108 ms (108/320 = 0.34), indicating that the location was within the center of the isthmus. (B) The sequential activation of fractionated potentials. (C) VT stopped during ablation. (D) The three-dimensional activation map (Ensite Navx Velocity) of this patient’s RV epicardium which shows a reentry in the RV free wall. (E) Fluorescence of the mapping catheters. DD: St Jude Medical DuoDeca catheter.</p

The substrate maps of the RV endocardium and epicardium of an ARVC patient (CARTO3 system).

<p>(A) The fractionated potentials are marked as blue dots within a low voltage zone and ablation energy was delivered within the low voltage zone with fractionated potentials in the RV endocardium. (B) This is the substrate map of the RV epicardium and ablation marks within the low voltage zone with fractionated potentials of the same patient.</p