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Heart Rhythm. 2019 Apr;16(4):536-543. doi: 10.1016/j.hrthm.2018.10.016. Epub 2018 Oct 24.

Ablation compared with drug therapy for recurrent ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy: Results from a multicenter study.

Author information

1
Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts; Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
2
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
3
Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland.
4
Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts; Cardiology Department, Westmead Hospital, Westmead, Sydney, New South Wales, Australia.
5
Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts; Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland.
6
Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
7
Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
8
Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano "San Carlo," Milan, Italy.
9
Department of Cardiac Electrophysiology, The Heart Hospital, Institute of Cardiovascular Science, University College London, London, United Kingdom.
10
Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: wstevenson@partners.org.

Abstract

BACKGROUND:

The comparative efficacy of antiarrhythmic drug (AAD) therapy vs ventricular tachycardia (VT) ablation in arrhythmogenic right ventricular cardiomyopathy (ARVC) is unknown.

OBJECTIVE:

We compared outcomes of AAD and/or β-blocker (BB) therapy with those of VT ablation (with AAD/BB) in patients with ARVC who had recurrent VT.

METHODS:

In a multicenter retrospective study, 110 patients with ARVC (mean age 38 ± 17 years; 91[83%] men) with a minimum of 3 VT episodes were included; 77 (70%) were initially treated with AAD/BB and 32 (29%) underwent ablation. Subsequently, 43 of the 77 patients treated with AAD/BB alone also underwent ablation. Overall, 75 patients underwent ablation.

RESULTS:

When comparing initial AAD/BB therapy (n = 77) and VT ablation (n = 32) after ≥3 VT episodes, a single ablation procedure rendered 35% of patients free of VT at 3 years compared with 28% of AAD/BB-only-treated patients (P = .46). Of the 77 AAD/BB-only-treated patients, 43 subsequently underwent ablation. For all 75 patients who underwent ablation, 56% were VT-free at 3 years after the last ablation procedure. Epicardial ablation was used in 40/75 (53%) and was associated with lower VT recurrence after the last ablation procedure (endocardial/epicardial vs endocardial-only; 71% vs 47% 3-year VT-free survival; P = .05). Importantly, there was no difference in survival free of death or transplantation between the ablation- and AAD/BB-only-treated patients (P = .61).

CONCLUSION:

In patients with ARVC and a high VT burden, mortality and transplantation-free survival are not significantly different between drug- and ablation-treated patients. These patients have a high risk of recurrent VT despite drug therapy. Combined endocardial/epicardial ablation is associated with reduced VT recurrence as compared with endocardial-only ablation.

KEYWORDS:

Arrhythmogenic right ventricular cardiomyopathy; Catheter ablation; Ventricular tachycardia

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