Cor Vasa 2013, 55(1):e15-e24 | DOI: 10.1016/j.crvasa.2012.11.014

Long-term results of catheter ablation for ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy/dysplasia

Martina Hrošová, Martin Fiala^*, Libor Škňouřil, Martin Pleva, Miloslav Dorda, Jan Chovančík, Štěpán Krawiec, Bronislav Holek, Jaroslav Januška

Oddělení kardiologie, Nemocnice Podlesí, a. s., Třinec, Česká republika

Aims: This study analyzed the arrhythmogenic substrates and mechanisms of ventricular tachycardia (VT), and long-term outcomes of catheter ablation in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D).

Methods: Nine patients (1 female, 40 ± 17 years) with ARVC/D and sustained monomorphic VT (SMVT) exhibiting left bundle branch block morphology of the QRS complex were studied. The diagnosis of ARVC/D was confirmed by means of echocardiography, magnetic resonance imaging, and electroanatomical mapping in all patients.

Results: The patients underwent 10 ablation procedures. At the initial ablation, the mean VT rate was 196 ± 21 (170-240) bpm. In total, 17 VT types were observed. One VT type with left axis (+I, aVL), or right axis (+II, III, aVF) of the QRS complex was present in 3 and 1 patient, respectively. Two VT types of left and interme-diate (+I, II, aVL) axis or of left and right axis of the QRS complex were observed in 3 and 2 patients, respectively. Multiple VT types with left axis QRS complex recurred in 1 patient. One VT displayed characteristics of focal arrhythmia, the mechanism of remaining VTs was clearly macroreentrant. The critical slow-conducting isthmus of the reentry circuit was located at the infero-lateral aspect of tricuspid annulus and was bounded by the annulus and baso-lateral wall scar in 7 VTs, the isthmus was located within the scars in the remaining VTs. During 52 ± 31 (12-93) month follow-up since the last ablation, 8 (89%) patients remained free from any VT recurrence without antiarrhythmic drug.

Conclusions: Patients with ARVC/D frequently presented with ≥ 1 SMVT type. The critical isthmus of reentry circuit was dominantly located close to the tricuspid annulus. Long-term outcome of extensive endocardial ablation was favorable with isolated VT recurrences in one patient.

Keywords: ARVC, D; Catheter ablation; Outcomes; Ventricular tachycardia

Received: September 23, 2012; Revised: November 12, 2012; Accepted: November 15, 2012; Published: February 1, 2013  Show citation