Ablation of ventricular arrhythmias in arrhythmogenic right ventricular dysplasia/cardiomyopathy: arrhythmia-free survival after endo-epicardial substrate based mapping and ablation
| Autor: | Gemma Pelargonio, Atul Verma, Antonio Russo, Sanghamitra Mohanty, Kalyanam Shivkumar, Pietro Santarelli, Salwa Beheiry, Richard Hongo, Rong Bai, Luigi Di Biase, Claudio Tondo, Miguel Vacca, Roderick Tung, J. David Burkhardt, Prasant Mohanty, Javier Sanchez, Michela Casella, Luis C. Saenz, Pasquale Santangeli, Yariv Khaykin, Andrea Natale |
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| Rok vydání: | 2011 |
| Předmět: |
Tachycardia
Adult Male medicine.medical_specialty medicine.medical_treatment Cardiomyopathy Ventricular tachycardia Disease-Free Survival Electrocardiography Recurrence Physiology (medical) Internal medicine medicine Humans Prospective Studies Endocardium Arrhythmogenic Right Ventricular Dysplasia End point medicine.diagnostic_test business.industry Incidence Middle Aged medicine.disease Ablation Arrhythmogenic right ventricular dysplasia Defibrillators Implantable Treatment Outcome cardiovascular system Cardiology Catheter Ablation Tachycardia Ventricular Female medicine.symptom Cardiology and Cardiovascular Medicine business Electrophysiologic Techniques Cardiac Pericardium Follow-Up Studies |
| Zdroj: | Circulation. Arrhythmia and electrophysiology. 4(4) |
| ISSN: | 1941-3084 |
| Popis: | Background— In patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy, freedom from ventricular arrhythmias (VAs) after endocardial ablation is limited. We compared the long-term freedom from recurrent VAs by using endocardial-alone ablation versus endo-epicardial substrate-based ablation. Methods and Results— Forty-nine patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy undergoing ablation of ventricular tachycardia (VT) were divided into 2 groups: endocardial-alone ablation (group 1, n=23) and endo-epicardial ablation (group 2, n=26). All patients had an implantable cardioverter-defibrillator (ICD). Conventional and 3D mappings were used to determine the mechanism of induced VTs and to identify area of “scar” or “abnormal” myocardium. All critical sites responsible for VTs and points with “abnormal” potential were targeted for ablation from endocardium (group 1) or from both endocardium and epicardium (group 2). The procedural end point was noninducibility of sustained, monomorphic VT with isoproterenol. The presence of frequent premature ventricular contractions at the end of ablation was recorded. Patients were followed up by ECG, Holter, and ICD interrogation. After a follow-up of at least 3 years, freedom from VAs or ICD therapy was 52.2% (12/23) in group 1 and 84.6% (22/26) in group 2 ( P =0.029), with 21.7% (5/23) and 69.2% (18/26) patients off antiarrhythmic drugs ( P P Conclusions— An endo-epicardial–based ablation strategy achieves higher long-term freedom from recurrent VAs off antiarrhythmic therapy in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy when compared with endocardial-alone ablation. The presence of ≥10 premature ventricular contractions per minute after ablation is associated with more VA recurrence. |
| Databáze: | OpenAIRE |
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