Author + information
- Received July 27, 2018
- Revision received September 18, 2018
- Accepted September 28, 2018
- Published online November 28, 2018.
- Pasquale Santangeli, MD, PhDa,
- Roderick Tung, MDb,c,
- Yumei Xue, MDc,
- Fa-Po Chung, MDd,
- Yenn-Jiang Lin, MDd,
- Luigi Di Biase, MD, PhDe,f,
- Xianzhang Zhan, MDc,
- Chin-Yu Lin, MDd,
- Wei Wei, MDc,
- Sanghamitra Mohanty, MDe,
- David J. Burkhardt, MDe,
- Erica S. Zado, PA-Ca,
- David J. Callans, MDa,
- Francis E. Marchlinski, MDa,
- Shulin Wu, MDc,
- Shih-Ann Chen, MDd,∗∗ ( and )
- Andrea Natale, MDe,∗ ()
- aCardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- bCenter for Arrhythmia Care, University of Chicago Medicine, Pritzker School of Medicine, Chicago, Illinois
- cGuangdong General Hospital, Guangzhou, China
- dDivision of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- eTexas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, Texas
- fDivision of Cardiovascular Disease, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
- ↵∗Address for correspondence:
Dr. Andrea Natale, Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, 1015 East 32nd Street, Suite 516, Austin, Texas 78705.
- ↵∗∗Dr. Shih-Ann Chen, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.
Objectives This study sought to determine the long-term outcomes of catheter ablation (CA) of ventricular tachycardia (VT) in a series of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) without background implantable cardioverter-defibrillator (ICD) therapy.
Background Endo-epicardial CA of VT has been demonstrated to be highly effective in reducing recurrent VT in patients with ARVC.
Methods Thirty-two patients (age 45 ± 13 years, 72% male) with ARVC and VT underwent CA in the absence of ICD therapy. ICD was recommended in all cases, but implantation was not performed due to patient refusal (63%) or financial hardship (37%). CA was guided by activation/entrainment mapping for mappable VT and pace mapping/targeting of abnormal substrate in cases of unmappable VT.
Results Symptoms associated with clinical VT included palpitations (78%), chest pain and shortness of breath (22%), pre-syncope (16%), and syncope (13%). Prior to ablation, 22 patients (69%) failed a mean of 1.3 ± 0.5 antiarrhythmic drugs. Epicardial mapping and ablation was performed as first-line strategy (20 [63%]) or in case of recurrent VT or persistent inducibility after endocardial-only ablation (3 [9%]—surgical epicardial cryoablation in 1 patient). After a mean of 1.6 (range 1 to 3) procedures, all patients demonstrated noninducibility of sustained VT from at least 2 RV sites; 75% also had stimulation on isoproterenol with no inducible VT. At a median follow-up of 46 months (range 26 to 65 months) following the last ablation, no deaths were observed and freedom from recurrent VT was 81%.
Conclusions In this multicenter international registry of patients with ARVC and VT, CA performed in the absence of background ICD was associated with a low rate of symptomatic VT recurrence (19%) without mortality during 46-month median follow-up. These data suggest that further prospective studies may refine selection of patients with structural heart disease at low risk for SCD, possibly obviating the benefit of ICD therapy.
- arrhythmogenic right ventricular cardiomyopathy
- catheter ablation
- long-term outcome
- ventricular tachycardia
Drs. Santangeli and Marchlinski are supported by the Winkelman Family Fund in Cardiovascular Innovation. Dr. Di Biase has received consulting fees from Biosense Webster, Stereotaxis, Boston Scientific, and St. Jude Medical; and speaker/travel honoraria from Medtronic, Atricure, EPiEP, Pfizer, Bristol-Myers Squibb, and Biotronik. Dr. Burkhardt has received speaking/consulting honoraria from Biosense Webster and Stereotaxis. Dr. Natale has received consulting fees from Biosense Webster, Stereotaxis, Boston Scientific, and St. Jude Medical; and speaking/travel honoraria from Medtronic, Atricure, EPiEP, Janssen, and Biotronik. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Santangeli and Tung contributed equally to this work and are joint first authors.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received July 27, 2018.
- Revision received September 18, 2018.
- Accepted September 28, 2018.
- 2018 American College of Cardiology Foundation
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