Abstract 14044: The Presence of PVCs After Endocardial and/or Epicardial Ablation Predicts Recurrence at Follow-up in Patients Undergoing Catheter Ablation of Ventricular Arrhythmias for Right Ventricular Dysplasia
Introduction: In patients with arrhythmogenic right ventricular dysplasia (ARVD), freedom from ventricular arrhythmias (VAs) after endocardial ablation is limited at the long term follow-up. We compared the long term freedom from recurrent VAs by using endocardial substrate based ablation vs endo-epicardial substrate based ablation and identified predictors for procedural failure.
Methods: 42 patients with ARVD undergoing ablation of VAs have been included. All patients had an ICD. Conventional and 3D mappings were utilized to identify area of “scar”. Clinical VAs were induced with pacing maneuvers or administration of isoproterenol. In all cases ablation was performed with 3.5 mm open irrigated catheter. In 23 patients ablation was performed only endocardially (group 1), while in 19 endo-epicardial ablation after either failed endocardial ablation (10 pts) or at the time of the first procedure (9 pts) (group 2) was performed. After ablation pacing manuvers with and without isoproterenol were utilized to define ablation success.
Results: At the 3 year follow-up, freedom from VAs or ICD shocks was 52% (12/23) in group 1 and 84% (16/19) in group 2. Interestingly the presence of PVCs after ablation with or without isoproterenol was able to predict the success rate at follow up in both groups (fig/table).
Conclusions: At the long-term follow-up, endo-epicardial ablation achieves higher freedom from recurrent VAs in patients with ARVD when compared to endocardial ablation. Regardless of the ablation approach utilized the presence of PVCs after ablation predicted recurrence.
- © 2010 by American Heart Association, Inc.