Ablation compared with drug therapy for recurrent ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy: Results from a multicenter study.
- Mahida S Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts; Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
- Venlet J Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
- Saguner AM Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland.
- Kumar S Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts; Cardiology Department, Westmead Hospital, Westmead, Sydney, New South Wales, Australia.
- Baldinger SH Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts; Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland.
- AbdelWahab A Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
- Tedrow UB Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
- Castelletti S Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano "San Carlo," Milan, Italy.
- Pantazis A Department of Cardiac Electrophysiology, The Heart Hospital, Institute of Cardiovascular Science, University College London, London, United Kingdom.
- John RM Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
- McKenna WJ Department of Cardiac Electrophysiology, The Heart Hospital, Institute of Cardiovascular Science, University College London, London, United Kingdom.
- Lambiase PD Department of Cardiac Electrophysiology, The Heart Hospital, Institute of Cardiovascular Science, University College London, London, United Kingdom.
- Duru F Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland.
- Sapp JL Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
- Zeppenfeld K Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
- Stevenson WG Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: wstevenson@partners.org.
- 2018-10-27
Published in:
- Heart rhythm. - 2019
Arrhythmogenic right ventricular cardiomyopathy
Catheter ablation
Ventricular tachycardia
Adrenergic beta-Antagonists
Adult
Anti-Arrhythmia Agents
Arrhythmogenic Right Ventricular Dysplasia
Catheter Ablation
Epicardial Mapping
Female
Humans
Male
Recurrence
Retrospective Studies
Tachycardia, Ventricular
English
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.
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.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1016/j.hrthm.2018.10.016
- PMID 30366162
- Persistent URL
- https://sonar.ch/global/documents/52417
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