TY - JOUR
T1 - Ablation compared with drug therapy for recurrent ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy
T2 - Results from a multicenter study
AU - Mahida, Saagar
AU - Venlet, Jeroen
AU - Saguner, Ardan Muammer
AU - Kumar, Saurabh
AU - Baldinger, Samuel H.
AU - AbdelWahab, Amir
AU - Tedrow, Usha B.
AU - Castelletti, Silvia
AU - Pantazis, Antonis
AU - John, Roy M.
AU - McKenna, William J.
AU - Lambiase, Pier D.
AU - Duru, Firat
AU - Sapp, John L.
AU - Zeppenfeld, Katja
AU - Stevenson, William G.
PY - 2019/4
Y1 - 2019/4
N2 - 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.
AB - 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.
KW - Arrhythmogenic right ventricular cardiomyopathy
KW - Catheter ablation
KW - Ventricular tachycardia
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U2 - 10.1016/j.hrthm.2018.10.016
DO - 10.1016/j.hrthm.2018.10.016
M3 - Article
C2 - 30366162
AN - SCOPUS:85062956299
VL - 16
SP - 536
EP - 543
JO - Heart Rhythm
JF - Heart Rhythm
SN - 1547-5271
IS - 4
ER -