CLINICAL RESEARCH: HEART RHYTHM DISORDER
Long-Term Efficacy of Catheter Ablation of Ventricular Tachycardia in Patients With Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy
Darshan Dalal, MD, MPH,
Rahul Jain, MD,
Harikrishna Tandri, MD,
Jun Dong, MD, PhD,
Shaker M. Eid, MD,
Kalpana Prakasa, MD,
Crystal Tichnell, MGC,
Cynthia James, ScM, PhD,
Theodore Abraham, MD, FACC,
Stuart D. Russell, MD, FACC,
Sunil Sinha, MD,
Daniel P. Judge, MD,
David A. Bluemke, MD, PhD,
Joseph E. Marine, MD and
Hugh Calkins, MD, FACC*
Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Manuscript received December 20, 2006;
revised manuscript received February 20, 2007,
accepted March 20, 2007.
* Reprint requests and correspondence: Dr. Hugh Calkins, 600 North Wolfe Street, Carnegie 530, Baltimore, Maryland 21287. (Email: hcalkins{at}jhmi.edu).
Objectives: This study sought to evaluate the outcomes of radiofrequency catheter ablation (RFA) of ventricular tachycardia (VT) in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) patients. Particular focus was placed on defining the single-procedure efficacy over long-term follow-up.
Background: ARVD/C is an inherited cardiomyopathy characterized by VT and right ventricular dysfunction. Prior single-center studies have reported conflicting results concerning the efficacy of RFA of VT in ARVD/C patients.
Methods: The study population comprised 24 patients (age 36 ± 9 years, 11 male), enrolled in the Johns Hopkins ARVD registry, who underwent 1 or more RFA procedures for treatment of VT. Patients were followed up for 32 ± 36 months (range 1 day to 12 years). Recurrence was defined as the documentation of VT subsequent to the procedure.
Results: A total of 48 RFA procedures were performed using 3-dimensional electroanatomical (n = 10) or conventional (n = 38) mapping. Of these procedures, 22 (46%), 15 (31%), and 11 (23%) resulted in elimination of all inducible VTs, clinical VT but not all, and none of the inducible VTs, respectively. Forty (85%) procedures were followed by recurrence. The cumulative VT recurrence-free survival was 75%, 50%, and 25% after 1.5, 5, and 14 months, respectively. The cumulative VT recurrence-free survival did not differ by procedural success, mapping technique, or repetition of procedures. There was 1 procedure-related death.
Conclusions: Our study shows a high rate of recurrence in ARVD/C patients undergoing RFA of VT. This likely reflects the fact that ARVD/C is a diffuse cardiomyopathy with progressively evolving electrical substrate. Further studies are needed to define the precise role of RFA of VT in ARVD/C.
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Abbreviations and Acronyms
| | ARVD/C = arrhythmogenic right ventricular dysplasia/cardiomyopathy | | ICD = implantable cardioverter-defibrillator | | RFA = radiofrequency catheter ablation | | RV = right ventricle/ventricular | | VT = ventricular tachycardia |
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