Published Online
on June 13, 2005

A more recent version of this article appeared on June 21, 2005

This Article Full Text (PDF) All Versions of this Article: 111/24/3209    most recent CIRCULATIONAHA.104.510503v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Verma, A. Articles by Natale, A. Search for Related Content PubMed PubMed Citation Articles by Verma, A. Articles by Natale, A. Pubmed/NCBI databases Medline Plus Health Information Cardiomyopathy Related Collections Ablation/ICD/surgery

Submitted on September 30, 2004
Revised on February 18, 2005
Accepted on March 3, 2005

Short- and Long-Term Success of Substrate-Based Mapping and Ablation of Ventricular Tachycardia in Arrhythmogenic Right Ventricular Dysplasia

Atul Verma MD, Fethi Kilicaslan MD, Robert A. Schweikert MD, Gery Tomassoni MD, Antonio Rossillo MD, Nassir F. Marrouche MD, Volkan Ozduran MD, Oussama M. Wazni MD, Samy C. Elayi MD, Luis C. Saenz MD, Stephen Minor MD, Jennifer E. Cummings MD, J. David Burkhardt MD, Steven Hao MD, Salwa Beheiry RN, Patrick J. Tchou MD, and Andrea Natale MD^*

From the Section of Pacing and Electrophysiology (A.V., F.K., R.A.S., N.F.M., V.O., O.M.W., S.C.E., L.C.S., S.M., J.E.C., J.D.B., P.J.T., A.N.), Cleveland Clinic Foundation, Cleveland, Ohio; Lexington Cardiology Consultants (G.T.), Lexington, Ky; Umberto I Hospital (A.R.), Mestre (Venice), Italy; and Sutter Pacific Heart Centers (S.H., S.B.), San Francisco, Calif.

^* To whom correspondence should be addressed. E-mail: natalea{at}ccf.org.

Background--Multiple morphologies, hemodynamic instability, or noninducibility may limit ventricular tachycardia (VT) ablation in patients with arrhythmogenic right ventricular dysplasia (ARVD). Substrate-based mapping and ablation may overcome these limitations. We report the results and success of substrate-based VT ablation in ARVD.

Methods and Results--Twenty-two patients with ARVD were studied. Traditional mapping for VT was limited because of multiple/changing VT morphologies (n=14), nonsustained VT (n=10), or hemodynamic intolerance (n=5). Sinus rhythm CARTO mapping was performed to define areas of "scar" (<0.5 mV) and "abnormal" myocardium (0.5 to 1.5 mV). Ablation was performed in "abnormal" regions, targeting sites with good pace maps compared with the induced VT(s). Linear lesions were created in these areas to (1) connect the scar/abnormal region to a valve continuity or other scar or (2) encircle the scar/abnormal region. Eighteen patients had implanted cardioverter defibrillators, 15 had implanted cardioverter defibrillator therapies, and 7 had sustained VT (6 with syncope). VTs (3±2 per patient) were induced (cycle length, 339±94 ms), and scar was identified in all patients. Scar areas were related to the tricuspid annulus, proximal right ventricular outflow tract, and anterior/inferior-apical walls. Lesions connected abnormal regions to the annulus (n=12) or other scars (n=4) and/or encircled abnormal regions (n=13). Per patient, a mean of 38±22 radiofrequency lesions was applied. Short-term success was achieved in 18 patients (82%). VT recurred in 23%, 27%, and 47% of patients after 1, 2, and 3 years’ follow-up, respectively.

Conclusions--Substrate-based ablation of VT in ARVD can achieve a good short-term success rate. However, recurrences become increasingly common during long-term follow-up.

Key words: arrhythmogenic right ventricular dysplasia • ventricular tachycardia • ablation

This article has been cited by other articles:

				E. M. Aliot, W. G. Stevenson, J. M. Almendral-Garrote, F. Bogun, C. H. Calkins, E. Delacretaz, P. D. Bella, G. Hindricks, P. Jais, M. E. Josephson, et al. EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: Developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA) Europace, June 1, 2009; 11(6): 771 - 817. [Full Text] [PDF]

				D. Corrado, C. Basso, and G. Thiene Arrhythmogenic right ventricular cardiomyopathy: an update Heart, May 1, 2009; 95(9): 766 - 773. [Full Text] [PDF]

				B. Ozben, I. Altun, V. Sabri Hancer, A. K. Bilge, A. M. Tanrikulu, R. Diz-Kucukkaya, A. S. Fak, E. Yilmaz, and K. Adalet Angiotensin-converting enzyme gene polymorphism in arrhythmogenic right ventricular dysplasia: is DD genotype helpful in predicting syncope risk? Journal of Renin-Angiotensin-Aldosterone System, December 1, 2008; 9(4): 215 - 220. [Abstract] [PDF]

				D. Corrado, C. Basso, L. Leoni, B. Tokajuk, P. Turrini, B. Bauce, F. Migliore, A. Pavei, G. Tarantini, M. Napodano, et al. Three-Dimensional Electroanatomical Voltage Mapping and Histologic Evaluation of Myocardial Substrate in Right Ventricular Outflow Tract Tachycardia. J. Am. Coll. Cardiol., February 19, 2008; 51(7): 731 - 739. [Abstract] [Full Text] [PDF]

				F. E. Marchlinski Perivalvular Fibrosis and Monomorphic Ventricular Tachycardia: Toward a Unifying Hypothesis in Nonischemic Cardiomyopathy Circulation, October 30, 2007; 116(18): 1998 - 2001. [Full Text] [PDF]

				E. A. Stephenson and C. I. Berul Electrophysiological Interventions for Inherited Arrhythmia Syndromes Circulation, August 28, 2007; 116(9): 1062 - 1080. [Full Text] [PDF]

				D. Dalal, R. Jain, H. Tandri, J. Dong, S. M. Eid, K. Prakasa, C. Tichnell, C. James, T. Abraham, S. D. Russell, et al. Long-Term Efficacy of Catheter Ablation of Ventricular Tachycardia in Patients With Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy J. Am. Coll. Cardiol., July 31, 2007; 50(5): 432 - 440. [Abstract] [Full Text] [PDF]

				W. G. Stevenson and K. Soejima Catheter Ablation for Ventricular Tachycardia Circulation, May 29, 2007; 115(21): 2750 - 2760. [Full Text] [PDF]

				I. Bakir, P. Brugada, A. Sarkozy, C. Vandepitte, and F. Wellens A novel treatment strategy for therapy refractory ventricular arrhythmias in the setting of arrhythmogenic right ventricular dysplasia Europace, May 1, 2007; 9(5): 267 - 269. [Abstract] [Full Text] [PDF]