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

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.

• Authors: 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
• Journal: Heart rhythm (Heart Rhythm) Vol. 16 Issue 4 Pg. 536-543 (04 2019) ISSN: 1556-3871 [Electronic] United States
• PMID: 30366162 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2018. Published by Elsevier Inc.

Chemical References

• Adrenergic beta-Antagonists
• Anti-Arrhythmia Agents

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Adult
• Anti-Arrhythmia Agents (therapeutic use)
• Arrhythmogenic Right Ventricular Dysplasia (physiopathology, therapy)
• Catheter Ablation (methods)
• Epicardial Mapping
• Female
• Humans
• Male
• Recurrence
• Retrospective Studies
• Tachycardia, Ventricular (physiopathology, therapy)