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Publication Detail
Ablation Compared to Drug Therapy for Recurrent Ventricular Tachycardia in Arrhythmogenic Right Ventricular Cardiomyopathy; Results from a Multicenter Study.
  • Publication Type:
    Journal article
  • Publication Sub Type:
    Article
  • Authors:
    Mahida S, Venlet J, Saguner AM, Kumar S, Baldinger SH, AbdelWahab A, Tedrow UB, Castelletti S, Pantazis A, John RM, McKenna WJ, Lambiase PD, Duru F, Sapp JL, Zeppenfeld K, Stevenson WG
  • Publication date:
    01/04/2019
  • Journal:
    Heart Rhythm
  • Status:
    Published
  • Country:
    United States
  • PII:
    S1547-5271(18)31043-9
  • Language:
    eng
  • Keywords:
    Arrhythmogenic right ventricular cardiomyopathy, catheter ablation, ventricular tachycardia
Abstract
BACKGROUND: The comparative efficacy of antiarrhythmic drug therapy (AAD) versus ventricular tachycardia (VT) ablation in arrhythmogenic right ventricular cardiomyopathy (ARVC) is unknown. OBJECTIVES: We compared outcomes of AAD and/or beta blocker (BB) therapy to VT ablation (with AAD/BB) in ARVC patients with recurrent VT. METHODS: In a multicenter retrospective study, 110 ARVC patients (38±17 years, 83% male) 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-only 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 to 28% of AAD/BB-only treated patients (p=0.46). Of the 77 AAD/BB treated patients, 43 subsequently had ablation. For all 75 patients who had ablation, 56% were VT-free at 3 years after the last ablation. Epicardial ablation was used in 53% and was associated with lower VT recurrence after the last ablation (endocardial/epicardial vs. endocardial-only; 71% vs. 47% three-year VT-free survival, p=0.05). Importantly, there was no difference in survival free of death or transplantation between the ablation- and AAD/BB-only treated patients (p=0.61). CONCLUSION: Amongst ARVC patients with a high VT burden, mortality and transplantation-free survival is 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 compared to endocardial-only ablation.
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