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

Saagar Mahida, Jeroen Venlet, Ardan Muammer Saguner, Saurabh Kumar, Samuel H. Baldinger, Amir AbdelWahab, Usha B. Tedrow, Silvia Castelletti, Antonis Pantazis, Roy M. John, William J. McKenna, Pier D. Lambiase, Firat Duru, John L. Sapp, Katja Zeppenfeld, William G. Stevenson

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)536-543
Number of pages8
JournalHeart Rhythm
Volume16
Issue number4
DOIs
Publication statusPublished - Apr 2019

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Keywords

  • Arrhythmogenic right ventricular cardiomyopathy
  • Catheter ablation
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Mahida, S., Venlet, J., Saguner, A. M., Kumar, S., Baldinger, S. H., AbdelWahab, A., Tedrow, U. B., Castelletti, S., Pantazis, A., John, R. M., McKenna, W. J., Lambiase, P. D., Duru, F., Sapp, J. L., Zeppenfeld, K., & Stevenson, W. G. (2019). Ablation compared with drug therapy for recurrent ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy: Results from a multicenter study. Heart Rhythm, 16(4), 536-543. https://doi.org/10.1016/j.hrthm.2018.10.016