Header

UZH-Logo

Maintenance Infos

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


Mahida, Saagar; Venlet, Jeroen; Saguner, Ardan Muammer; Kumar, Saurabh; Baldinger, Samuel H; AbdelWahab, Amir; Tedrow, Usha B; Castelletti, Silvia; Pantazis, Antonis; John, Roy M; McKenna, William J; Lambiase, Pier D; Duru, Firat; Sapp, John L; Zeppenfeld, Katja; Stevenson, William G (2019). Ablation compared with drug therapy for recurrent ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy: Results from a multicenter study. Heart Rhythm, 16(4):536-543.

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; 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 had ablation. For all 75 patients who had ablation, 56% were VT-free at 3 years after the last ablation procedure. Epicardial ablation was used in 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.

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; 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 had ablation. For all 75 patients who had ablation, 56% were VT-free at 3 years after the last ablation procedure. Epicardial ablation was used in 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.

Statistics

Citations

Dimensions.ai Metrics

Altmetrics

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:1 April 2019
Deposited On:28 Feb 2019 10:21
Last Modified:29 Mar 2019 02:05
Publisher:Elsevier
ISSN:1547-5271
OA Status:Closed
Publisher DOI:https://doi.org/10.1016/j.hrthm.2018.10.016
PubMed ID:30366162

Download

Full text not available from this repository.
View at publisher

Get full-text in a library