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. 2024 Jul;10(7 Pt 2):1551-1561.
doi: 10.1016/j.jacep.2024.05.003. Epub 2024 May 16.

Long-Term Freedom From Ventricular Arrhythmias in ARVC With Endocardial Only Ablation: Predictors of Success

Corentin Chaumont  1 , Cory M Tschabrunn  2 , Alireza Oraii  2 , Erica S Zado  2 , Haran Yogasundaram  2 , Adrian Petzl  2 , Michal Wasiak  2 , Oriol Rodriguez-Queralto  2 , Helena Lopez-Martinez  2 , Timothy M Markman  2 , Ramanan Kumareswaran  2 , Sanjay Dixit  2 , Fermin C Garcia  2 , David Lin  2 , Michael P Riley  2 , Gregory E Supple  2 , Matthew C Hyman  2 , Saman Nazarian  2 , David J Callans  2 , David S Frankel  2 , Frederic Anselme  3 , Francis E Marchlinski  4
Affiliations

Long-Term Freedom From Ventricular Arrhythmias in ARVC With Endocardial Only Ablation: Predictors of Success

Corentin Chaumont et al. JACC Clin Electrophysiol. 2024 Jul.

Abstract

Background: Although the epicardial predominance of substrate abnormalities has been well demonstrated in early stages of arrhythmogenic right ventricular cardiomyopathy (ARVC), endocardial (ENDO) ablation may suffice to eliminate ventricular tachycardia (VT) in some patients.

Objectives: This study aimed to report the long-term outcomes of ENDO-only ablation in ARVC patients and factors that predict VT-free survival.

Methods: We included consecutive patients with Task Force Criteria diagnosis of ARVC undergoing a first ENDO-only VT ablation between 1998 and 2020. Ablation was predominantly guided by activation/entrainment mapping for mappable VTs and pace mapping/targeting abnormal electrograms for unmappable VTs. The primary endpoint was freedom from any recurrent sustained VT after the last ENDO-only ablation.

Results: Seventy-four ARVC patients underwent ENDO-only VT ablation. VT noninducibility was achieved in 49 (66%) patients. During median follow-up of 6.6 years (Q1-Q3: 3.4-11.2 years), 40 (54.1%) patients remained free from any VT recurrence with rare VT ≤2 episodes in additional 12.2%. Among patients with noninducibility, VT-free survival was 75.5% during long-term follow-up. In multivariable analysis, >45 y of age at diagnosis (HR: 0.41; 95% CI: 0.17-0.98) and VT noninducibility (HR: 0.36; 95% CI: 0.16-0.80) were predictors of VT-free survival.

Conclusions: Long-term VT-free survival can be achieved in over half of ARVC patients following ENDO-only VT ablation, increasing to over 75% if VT noninducibility is achieved. Our results support consideration of a stepwise ENDO-only approach before proceeding to epicardial ablation if VT noninducibility can be achieved particularly in older patients.

Keywords: arrhythmogenic right ventricular cardiomyopathy; catheter ablation; endocardial; ventricular tachycardia.

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Conflict of interest statement

Funding Support and Author Disclosures This work was supported by the Winkelman Family Fund in Cardiovascular Innovation, Katherine J. Miller EP Research Fund, Bogle Family Fund in Cardiac Electrophysiology, and F. Harlan Batrus EP Research Fund. Dr Chaumont acknowledges the Fédération Française de Cardiologie, Fondation Charles Nicolle-Normandie, GSC G4, Working Group of Pacing and Electrophysiology of the French Society of Cardiology, and Philippe Foundation. Dr Nazarian has served as a consultant for and received research funding from Biosense Webster Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.