Endo-epicardial ablation vs endocardial ablation for the management of ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy: A systematic review and meta-analysis

Jorge Romero, Kavisha Patel, David Briceno, Isabella Alviz, Mohamed Gabr, Juan Carlos Diaz, Chintan Trivedi, Sanghamitra Mohanty, Domenico Della Rocca, Amin Al-Ahmad, Ruike Yang, Saul Rios, Luis Cerna, Xianfeng Du, Nicola Tarantino, Xiao Dong Zhang, Dhanunjaya Lakkireddy, Andrea Natale, Luigi Di Biase

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: The pathologic process of ARVC (arrhythmogenic right ventricular cardiomyopathy) typically originates in the epicardium or subepicardial layers with progression toward endocardium. However, in the most recent ARVC international task force consensus statement, epicardial ventricular tachycardia (VT) ablation is recommended as a Class I indication only in patients with at least one failed endocardial VT ablation attempt. Objective: The aim of this meta-analysis is to assess the outcomes of ARVC patients undergoing combined endo-epicardial VT ablation, as compared to endocardial ablation alone. Methods: A systematic review of PubMed, Embase, and Cochrane was performed for studies reporting clinical outcomes of endo-epicardial VT ablation vs endocardial-only VT ablation in patients with ARVC. Fixed-Effect model was used if I2 < 25 and the Random-Effects Model was used if I2 ≥ 25%. Results: Nine studies consisting of 452 patients were included (mean age 42.3 ± 5.7 years; 70% male). After a mean follow-up of 48.1 ± 21.5 months, endo-epicardial ablation was associated with 42% relative risk reduction in VA recurrence as opposed to endocardial ablation alone (risk ratio [RR], 0.58; 95% confidence interval [CI], 0.45-0.75; P <.0001). No significant differences were noted between endo-epicardial and endocardial VT ablation groups in terms of all-cause mortality (RR, 1.19; 95% CI, 0.03-47.08; P =.93) and acute procedural complications (RR, 5.39; 95% CI, 0.60-48.74; P =.13). Conclusions: Our findings suggest that in patients with ARVC, endo-epicardial VT ablation is associated with a significant reduction in VA recurrence as opposed to endocardial ablation alone, without a significant difference in all-cause mortality or acute procedural complications.

Original languageEnglish (US)
Pages (from-to)2022-2031
Number of pages10
JournalJournal of cardiovascular electrophysiology
Volume31
Issue number8
DOIs
StatePublished - Aug 1 2020

Keywords

  • arrhythmogenic right ventricular cardiomyopathy
  • endocardial ablation
  • endocardial-epicardial ablation
  • mortality
  • ventricular arrhythmia recurrence
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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