Catheter ablation of electrical storm in patients with arrhythmogenic right ventricular cardiomyopathy.

Abstract

BACKGROUND:

Therapeutic strategies for electrical storm (ES) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) are not well defined.

OBJECTIVE:

The purpose of this study was to report the acute and long-term results of ventricular tachycardia (VT) radiofrequency catheter ablation (RFCA) as a treatment of ES in patients with ARVC.

METHODS:

This multicenter study retrospectively enrolled 23 consecutive patients with ARVC (mean age 43.6 ± 16.7 years; all men) who underwent 24 RFCA procedures for ES between 2003 and 2015.

RESULTS:

Thirteen patients (57%) had a previous VT RFCA procedure; 14 (61%) had right ventricular dysfunction and 7 (30%) left ventricular ejection fraction ≤ 50%. The clinical VT was inducible in 19 procedures (79%). Epicardial ablation was performed in 4 procedures (17%). The median number of targeted VTs was 1 (range 1-6). Complete acute success (no VT inducible) was achieved in 11 procedures (46%) and partial acute success (clinical VT nor inducible) in 11 (46%). After a median follow-up of 3.9 years (range 1 month-10 years), ES recurred in 2 patients and end-stage heart failure developed in 4 (17%), leading to 1 death and 3 heart transplantations. At 1-year follow-up, the probability of freedom from VT recurrence was 75% and did not significantly predict long-term survival. At the last evaluation, 8 patients (35%) were free of non-β-blocker antiarrhythmic drugs as compared with 1 (4%) at baseline (P = .02).

CONCLUSION:

Catheter ablation was efficient to prevent ES recurrence in patients with ARVC. However, these patients were at high risk of evolution toward ARVC-related heart failure that was not associated with VT recurrence.

• Authors: Mikael Laredo, Ludivine Oliveira Da Silva, Fabrice Extramiana, Nicolas Lellouche, Émilie Varlet, Denis Amet, Vincent Algalarrondo, Xavier Waintraub, Guillaume Duthoit, Nicolas Badenco, Carole Maupain, Francoise Hidden-Lucet, Philippe Maury, Estelle Gandjbakhch, GPUR Groupe Parisien Universitaire en Rythmologie Investigators
• Journal: Heart rhythm (Heart Rhythm) Vol. 17 Issue 1 Pg. 41-48 (01 2020) ISSN: 1556-3871 [Electronic] United States
• PMID: 31284048 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Arrhythmogenic Right Ventricular Dysplasia (physiopathology, surgery)
• Catheter Ablation (methods)
• Electrocardiography
• Female
• Heart Conduction System (physiopathology)
• Heart Rate (physiology)
• Humans
• Male
• Recurrence
• Retrospective Studies
• Stroke Volume (physiology)
• Treatment Outcome
• Ventricular Function, Left (physiology)