1. Hybrid-Approach Ablation in Drug-Refractory Arrhythmogenic Right Ventricular Cardiomyopathy
- Author
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Cinzia Monaco, Alessio Galli, Luigi Pannone, Antonio Bisignani, Vincenzo Miraglia, Anaïs Gauthey, Maysam Al Housari, Joerelle Mojica, Alvise Del Monte, Felicia Lipartiti, Sergio Rizzi, Sahar Mouram, Paul-Adrian Calburean, Robbert Ramark, Gudrun Pappaert, Ivan Eltsov, Gezim Bala, Antonio Sorgente, Ingrid Overeinder, Alexandre Almorad, Erwin Stroker, Juan Sieira, Pedro Brugada, Gian Battista Chierchia, Mark La Meir, Carlo de Asmundis, Faculty of Medicine and Pharmacy, Heartrhythmmanagement, Clinical sciences, Cardio-vascular diseases, Medical Imaging, Vascular surgery, and Cardiac Surgery
- Subjects
arrhythmogenic right ventricular cardiomyopathy ,Treatment Outcome ,implantable cardioverter-defibrillator ,Recurrence ,Tachycardia, Ventricular ,Catheter Ablation ,Humans ,Cardiology and Cardiovascular Medicine ,Arrhythmogenic Right Ventricular Dysplasia - Abstract
Management of ventricular arrhythmias (VAs) beyond implantable cardioverter-defibrillator positioning in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) is challenging. Catheter ablation of the ventricular substrate often requires a combination of endocardial and epicardial approaches, with disappointing outcomes due to the progressive nature of the disease. We report the Universitair Ziekenhuis Brussel experience through a case series of 16 patients with drug-refractory ARVC, who have undergone endocardial and/or epicardial catheter ablation of VAs with a thoracoscopic hybrid-approach. After a mean follow-up time of 5.16 years (SD 2.9 years) from the first hybrid-approach ablation, VA recurrence was observed in 5 patients (31.25%): among these, patients 4 patients (80%) received a previous ablation and 1 of 11 patients (9.09%) who had a hybrid ablation as first approach had a VA recurrence (80% vs 9.09%; log-rank p = 0.04). Despite the recurrence rate of arrhythmic events, all patients had a significant reduction in the arrhythmic burden after ablation, with a mean of 4.65 years (SD 2.9 years) of freedom from clinically significant arrhythmias, defined as symptomatic VAs or implantable cardioverter-defibrillator-delivered therapies. In conclusion, our case series confirms that management of VAs in patients with ARVC is difficult because patients do not always respond to antiarrhythmic medications and can require multiple invasive procedures. A multidisciplinary approach involving cardiologists, cardiac surgeons, and cardiac electrophysiologists, together with recent cardiac mapping techniques and ablation tools, might mitigate these difficulties and improve outcomes.
- Published
- 2022