TY - JOUR
T1 - Outcomes after catheter ablation of ventricular tachycardia without implantable cardioverter-defibrillator in selected patients with arrhythmogenic right ventricular cardiomyopathy
AU - Gandjbakhch, E.
AU - Laredo, M.
AU - Berruezo, A.
AU - Gourraud, J.B.
AU - Sellal, J.M.
AU - Martins, R.
AU - Sacher, F.
AU - Pison, L.
AU - Pruvot, E.
AU - Jauregui, B.
AU - Frontera, A.
AU - Kumar, S.
AU - Wong, T.
AU - DellaBella, P.
AU - Maury, P.
N1 - Publisher Copyright:
© 2021 Published on behalf of the European Society of Cardiology. All rights reserved.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - 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].
AB - 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].
KW - Arrhythmogenic right ventricular cardiomyopathy
KW - Sudden cardiac death
KW - Monomorphic ventricular tachycardia
KW - Catheter ablation
KW - Implantable cardioverter-defibrillator
KW - Epicardial ablation
KW - RISK STRATIFICATION
KW - THERAPY
KW - DYSPLASIA/CARDIOMYOPATHY
KW - PREDICTORS
KW - MANAGEMENT
KW - SUBSTRATE
KW - DIAGNOSIS
U2 - 10.1093/europace/euab172
DO - 10.1093/europace/euab172
M3 - Article
C2 - 34427302
SN - 1099-5129
VL - 23
SP - 1428
EP - 1436
JO - EP Europace
JF - EP Europace
IS - 9
ER -