Ablation of ventricular arrhythmias in arrhythmogenic right ventricular dysplasia/cardiomyopathy

Arrhythmia-free survival after endo-epicardial substrate based mapping and ablationablation of ventricular arrhythmias in arrhythmogenic right ventricular dysplasia/cardiomyopathy arrhythmia-free survival after endo-epicardial substrate based mapping and ablation

Rong Bai, Luigi Di Biase, Kalyanam Shivkumar, Prasant Mohanty, Roderick Tung, Pasquale Santangeli, Luis Saenz Carlos, Miguel Vacca, Atul Verma, Yariv Khaykin, Sanghamitra Mohanty, J. David Burkhardt, Richard Hongo, Salwa Beheiry, Antonio Dello Russo, Michela Casella, Gemma Pelargonio, Pietro Santarelli, Javier Sanchez, Claudio Tondo & 1 others Andrea Natale

Research output: Contribution to journalArticle

137 Citations (Scopus)

Abstract

Background-In patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy, freedom from ventricular arrhythmias (VAs) after endocardial ablation is limited. We compared the long-term freedom from recurrent VAs by using endocardial-alone ablation versus endo-epicardial substrate-based ablation. Methods and Results-Forty-nine patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy undergoing ablation of ventricular tachycardia (VT) were divided into 2 groups: endocardial-alone ablation (group 1, n=23) and endo-epicardial ablation (group 2, n=26). All patients had an implantable cardioverter-defibrillator (ICD). Conventional and 3D mappings were used to determine the mechanism of induced VTs and to identify area of "scar" or "abnormal" myocardium. All critical sites responsible for VTs and points with "abnormal" potential were targeted for ablation from endocardium (group 1) or from both endocardium and epicardium (group 2). The procedural end point was noninducibility of sustained, monomorphic VT with isoproterenol. The presence of frequent premature ventricular contractions at the end of ablation was recorded. Patients were followed up by ECG, Holter, and ICD interrogation. After a follow-up of at least 3 years, freedom from VAs or ICD therapy was 52.2% (12/23) in group 1 and 84.6% (22/26) in group 2 (P=0.029), with 21.7% (5/23) and 69.2% (18/26) patients off antiarrhythmic drugs (P<0.001), respectively. Compared with patients with no premature ventricular contractions after ablation, patients with frequent premature ventricular contractions after ablation were more likely to have VA recurrence/ICD therapy [3/33 (9%) versus 12/16 (75%); log-rank P<0.001]. Conclusions-An endo-epicardial- based ablation strategy achieves higher long-term freedom from recurrent VAs off antiarrhythmic therapy in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy when compared with endocardial-alone ablation. The presence of ≥10 premature ventricular contractions per minute after ablation is associated with more VA recurrence.

Original languageEnglish (US)
Pages (from-to)478-485
Number of pages8
JournalCirculation: Arrhythmia and Electrophysiology
Volume4
Issue number4
DOIs
StatePublished - Aug 2011
Externally publishedYes

Fingerprint

Arrhythmogenic Right Ventricular Dysplasia
Cardiac Arrhythmias
Ventricular Premature Complexes
Survival
Implantable Defibrillators
Endocardium
Ventricular Tachycardia
Recurrence
Pericardium
Anti-Arrhythmia Agents
Isoproterenol
Cicatrix
Myocardium
Electrocardiography
Therapeutics

Keywords

  • Ablation
  • Arrhythmogenic right ventricular dysplasia
  • Cardiomyopathy
  • Epicardial
  • Premature ventricular contraction
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)
  • Medicine(all)

Cite this

Ablation of ventricular arrhythmias in arrhythmogenic right ventricular dysplasia/cardiomyopathy : Arrhythmia-free survival after endo-epicardial substrate based mapping and ablationablation of ventricular arrhythmias in arrhythmogenic right ventricular dysplasia/cardiomyopathy arrhythmia-free survival after endo-epicardial substrate based mapping and ablation. / Bai, Rong; Di Biase, Luigi; Shivkumar, Kalyanam; Mohanty, Prasant; Tung, Roderick; Santangeli, Pasquale; Carlos, Luis Saenz; Vacca, Miguel; Verma, Atul; Khaykin, Yariv; Mohanty, Sanghamitra; Burkhardt, J. David; Hongo, Richard; Beheiry, Salwa; Russo, Antonio Dello; Casella, Michela; Pelargonio, Gemma; Santarelli, Pietro; Sanchez, Javier; Tondo, Claudio; Natale, Andrea.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 4, No. 4, 08.2011, p. 478-485.

Research output: Contribution to journalArticle

Bai, Rong ; Di Biase, Luigi ; Shivkumar, Kalyanam ; Mohanty, Prasant ; Tung, Roderick ; Santangeli, Pasquale ; Carlos, Luis Saenz ; Vacca, Miguel ; Verma, Atul ; Khaykin, Yariv ; Mohanty, Sanghamitra ; Burkhardt, J. David ; Hongo, Richard ; Beheiry, Salwa ; Russo, Antonio Dello ; Casella, Michela ; Pelargonio, Gemma ; Santarelli, Pietro ; Sanchez, Javier ; Tondo, Claudio ; Natale, Andrea. / Ablation of ventricular arrhythmias in arrhythmogenic right ventricular dysplasia/cardiomyopathy : Arrhythmia-free survival after endo-epicardial substrate based mapping and ablationablation of ventricular arrhythmias in arrhythmogenic right ventricular dysplasia/cardiomyopathy arrhythmia-free survival after endo-epicardial substrate based mapping and ablation. In: Circulation: Arrhythmia and Electrophysiology. 2011 ; Vol. 4, No. 4. pp. 478-485.
@article{8575152891de4ad1a12508c0f839adc5,
title = "Ablation of ventricular arrhythmias in arrhythmogenic right ventricular dysplasia/cardiomyopathy: Arrhythmia-free survival after endo-epicardial substrate based mapping and ablationablation of ventricular arrhythmias in arrhythmogenic right ventricular dysplasia/cardiomyopathy arrhythmia-free survival after endo-epicardial substrate based mapping and ablation",
abstract = "Background-In patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy, freedom from ventricular arrhythmias (VAs) after endocardial ablation is limited. We compared the long-term freedom from recurrent VAs by using endocardial-alone ablation versus endo-epicardial substrate-based ablation. Methods and Results-Forty-nine patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy undergoing ablation of ventricular tachycardia (VT) were divided into 2 groups: endocardial-alone ablation (group 1, n=23) and endo-epicardial ablation (group 2, n=26). All patients had an implantable cardioverter-defibrillator (ICD). Conventional and 3D mappings were used to determine the mechanism of induced VTs and to identify area of {"}scar{"} or {"}abnormal{"} myocardium. All critical sites responsible for VTs and points with {"}abnormal{"} potential were targeted for ablation from endocardium (group 1) or from both endocardium and epicardium (group 2). The procedural end point was noninducibility of sustained, monomorphic VT with isoproterenol. The presence of frequent premature ventricular contractions at the end of ablation was recorded. Patients were followed up by ECG, Holter, and ICD interrogation. After a follow-up of at least 3 years, freedom from VAs or ICD therapy was 52.2{\%} (12/23) in group 1 and 84.6{\%} (22/26) in group 2 (P=0.029), with 21.7{\%} (5/23) and 69.2{\%} (18/26) patients off antiarrhythmic drugs (P<0.001), respectively. Compared with patients with no premature ventricular contractions after ablation, patients with frequent premature ventricular contractions after ablation were more likely to have VA recurrence/ICD therapy [3/33 (9{\%}) versus 12/16 (75{\%}); log-rank P<0.001]. Conclusions-An endo-epicardial- based ablation strategy achieves higher long-term freedom from recurrent VAs off antiarrhythmic therapy in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy when compared with endocardial-alone ablation. The presence of ≥10 premature ventricular contractions per minute after ablation is associated with more VA recurrence.",
keywords = "Ablation, Arrhythmogenic right ventricular dysplasia, Cardiomyopathy, Epicardial, Premature ventricular contraction, Ventricular tachycardia",
author = "Rong Bai and {Di Biase}, Luigi and Kalyanam Shivkumar and Prasant Mohanty and Roderick Tung and Pasquale Santangeli and Carlos, {Luis Saenz} and Miguel Vacca and Atul Verma and Yariv Khaykin and Sanghamitra Mohanty and Burkhardt, {J. David} and Richard Hongo and Salwa Beheiry and Russo, {Antonio Dello} and Michela Casella and Gemma Pelargonio and Pietro Santarelli and Javier Sanchez and Claudio Tondo and Andrea Natale",
year = "2011",
month = "8",
doi = "10.1161/CIRCEP.111.963066",
language = "English (US)",
volume = "4",
pages = "478--485",
journal = "Circulation: Arrhythmia and Electrophysiology",
issn = "1941-3149",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Ablation of ventricular arrhythmias in arrhythmogenic right ventricular dysplasia/cardiomyopathy

T2 - Arrhythmia-free survival after endo-epicardial substrate based mapping and ablationablation of ventricular arrhythmias in arrhythmogenic right ventricular dysplasia/cardiomyopathy arrhythmia-free survival after endo-epicardial substrate based mapping and ablation

AU - Bai, Rong

AU - Di Biase, Luigi

AU - Shivkumar, Kalyanam

AU - Mohanty, Prasant

AU - Tung, Roderick

AU - Santangeli, Pasquale

AU - Carlos, Luis Saenz

AU - Vacca, Miguel

AU - Verma, Atul

AU - Khaykin, Yariv

AU - Mohanty, Sanghamitra

AU - Burkhardt, J. David

AU - Hongo, Richard

AU - Beheiry, Salwa

AU - Russo, Antonio Dello

AU - Casella, Michela

AU - Pelargonio, Gemma

AU - Santarelli, Pietro

AU - Sanchez, Javier

AU - Tondo, Claudio

AU - Natale, Andrea

PY - 2011/8

Y1 - 2011/8

N2 - Background-In patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy, freedom from ventricular arrhythmias (VAs) after endocardial ablation is limited. We compared the long-term freedom from recurrent VAs by using endocardial-alone ablation versus endo-epicardial substrate-based ablation. Methods and Results-Forty-nine patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy undergoing ablation of ventricular tachycardia (VT) were divided into 2 groups: endocardial-alone ablation (group 1, n=23) and endo-epicardial ablation (group 2, n=26). All patients had an implantable cardioverter-defibrillator (ICD). Conventional and 3D mappings were used to determine the mechanism of induced VTs and to identify area of "scar" or "abnormal" myocardium. All critical sites responsible for VTs and points with "abnormal" potential were targeted for ablation from endocardium (group 1) or from both endocardium and epicardium (group 2). The procedural end point was noninducibility of sustained, monomorphic VT with isoproterenol. The presence of frequent premature ventricular contractions at the end of ablation was recorded. Patients were followed up by ECG, Holter, and ICD interrogation. After a follow-up of at least 3 years, freedom from VAs or ICD therapy was 52.2% (12/23) in group 1 and 84.6% (22/26) in group 2 (P=0.029), with 21.7% (5/23) and 69.2% (18/26) patients off antiarrhythmic drugs (P<0.001), respectively. Compared with patients with no premature ventricular contractions after ablation, patients with frequent premature ventricular contractions after ablation were more likely to have VA recurrence/ICD therapy [3/33 (9%) versus 12/16 (75%); log-rank P<0.001]. Conclusions-An endo-epicardial- based ablation strategy achieves higher long-term freedom from recurrent VAs off antiarrhythmic therapy in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy when compared with endocardial-alone ablation. The presence of ≥10 premature ventricular contractions per minute after ablation is associated with more VA recurrence.

AB - Background-In patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy, freedom from ventricular arrhythmias (VAs) after endocardial ablation is limited. We compared the long-term freedom from recurrent VAs by using endocardial-alone ablation versus endo-epicardial substrate-based ablation. Methods and Results-Forty-nine patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy undergoing ablation of ventricular tachycardia (VT) were divided into 2 groups: endocardial-alone ablation (group 1, n=23) and endo-epicardial ablation (group 2, n=26). All patients had an implantable cardioverter-defibrillator (ICD). Conventional and 3D mappings were used to determine the mechanism of induced VTs and to identify area of "scar" or "abnormal" myocardium. All critical sites responsible for VTs and points with "abnormal" potential were targeted for ablation from endocardium (group 1) or from both endocardium and epicardium (group 2). The procedural end point was noninducibility of sustained, monomorphic VT with isoproterenol. The presence of frequent premature ventricular contractions at the end of ablation was recorded. Patients were followed up by ECG, Holter, and ICD interrogation. After a follow-up of at least 3 years, freedom from VAs or ICD therapy was 52.2% (12/23) in group 1 and 84.6% (22/26) in group 2 (P=0.029), with 21.7% (5/23) and 69.2% (18/26) patients off antiarrhythmic drugs (P<0.001), respectively. Compared with patients with no premature ventricular contractions after ablation, patients with frequent premature ventricular contractions after ablation were more likely to have VA recurrence/ICD therapy [3/33 (9%) versus 12/16 (75%); log-rank P<0.001]. Conclusions-An endo-epicardial- based ablation strategy achieves higher long-term freedom from recurrent VAs off antiarrhythmic therapy in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy when compared with endocardial-alone ablation. The presence of ≥10 premature ventricular contractions per minute after ablation is associated with more VA recurrence.

KW - Ablation

KW - Arrhythmogenic right ventricular dysplasia

KW - Cardiomyopathy

KW - Epicardial

KW - Premature ventricular contraction

KW - Ventricular tachycardia

UR - http://www.scopus.com/inward/record.url?scp=80054043363&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80054043363&partnerID=8YFLogxK

U2 - 10.1161/CIRCEP.111.963066

DO - 10.1161/CIRCEP.111.963066

M3 - Article

VL - 4

SP - 478

EP - 485

JO - Circulation: Arrhythmia and Electrophysiology

JF - Circulation: Arrhythmia and Electrophysiology

SN - 1941-3149

IS - 4

ER -