Outcomes after catheter ablation of ventricular tachycardia without implantable cardioverter-defibrillator in selected patients with arrhythmogenic right ventricular cardiomyopathy

E. Gandjbakhch, M. Laredo*, A. Berruezo, J.B. Gourraud, J.M. Sellal, R. Martins, F. Sacher, L. Pison, E. Pruvot, B. Jauregui, A. Frontera, S. Kumar, T. Wong, P. DellaBella, P. Maury

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Web of Science)

Abstract

Aims The roles of implantable cardioverter-defibrillators (ICDs) and radiofrequency catheter ablation (RCA) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and well-tolerated monomorphic ventricular tachycardia (MVT) are debated. In this multicentre retrospective study, we aimed at reporting the outcome of selected patients with ARVC after RCA without a back-up ICD.Methods and results Patients with ARVC who underwent RCA of well-tolerated MVT at 10 tertiary centres across 5 countries, without an ICD before and 3 months after RCA, without syncope or electrical storm, and with left ventricular ejection fraction >= 50% were included. In total, 65 ARVC patients [mean age 44.5 +/- 13.2 years, 78% males] underwent RCA of MVT between 2003 and 2016. Clinical presentation was palpitations in 51 (80%) patients. One (2%) patient had >1 clinical MVT. At the ablative procedure, clinical MVTs (mean rate 185 +/- 32 b.p.m.) were inducible in 50 (81%) patients. Epicardial ablation was performed in 19 (29%) patients. Complete acute success was achieved in 47 (72%) patients. After a median follow-up of 52.4 months (range 12.3-171.4), there was no death or aborted cardiac arrest, and VT recurred in 19 (29%) patients. Survival without VT recurrence was estimated at 88%, 80%, and 68%, 12, 36, and 60 months after RCA, respectively, and was significantly associated with the approach and the procedural outcome.Conclusion In patients with ARVC, well-tolerated MVT without a back-up ICD did not lead to fatal arrhythmic event after RCA despite VT recurrences in some. Our data suggest that RCA may be an alternative to ICD in selected ARVC patients.[GRAPHICS].
Original languageEnglish
Pages (from-to)1428-1436
Number of pages9
JournalEP Europace
Volume23
Issue number9
DOIs
Publication statusPublished - 1 Sep 2021

Keywords

  • Arrhythmogenic right ventricular cardiomyopathy
  • Sudden cardiac death
  • Monomorphic ventricular tachycardia
  • Catheter ablation
  • Implantable cardioverter-defibrillator
  • Epicardial ablation
  • RISK STRATIFICATION
  • THERAPY
  • DYSPLASIA/CARDIOMYOPATHY
  • PREDICTORS
  • MANAGEMENT
  • SUBSTRATE
  • DIAGNOSIS

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