Clinical Outcomes of Catheter Ablation of Ventricular Tachycardia in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy: Insights from the Johns Hopkins ARVC Program.

Abstract

BACKGROUND\nPrior studies of radiofrequency catheter ablation (RFA) of ventricular tachycardia (VT) in arrhythmogenic right ventricular cardiomyopathy (ARVC) patients, relying on limited numbers of procedures, have not reported VT-free survival in parallel for single and multiple procedures (i.e., after the last procedure). Additionally, there is a scarcity of data regarding the impact of RFA on VT burden.\n\n\nOBJECTIVES\nTo provide new insights regarding clinical outcomes based on a large series of VT ablation procedures from the current era in ARVC patients METHODS: We evaluated consecutive patients with definite ARVC who underwent RFA procedures between 2009 and 2019 at our center. We assessed VT-free survival, for single and multiple procedures, and changes in VT burden and anti-arrhythmic drugs (AADs) after RFA.\n\n\nRESULTS\nAmong 116 patients, there were 166 RFA procedures, 106 (63.9%) of which involved epicardial ablation. Cumulative freedom from VT after a single procedure was 68.6% and 49.8% at 1 and 5 years. Cumulative VT-free survival after multiple procedures was 81.8% and 69.6% at 1 and 5 years. VT burden per RFA was reduced after vs. before ablation (mean: 0.7 vs. 10.0 events/year, p<0.001). Further, VT burden per patient was reduced after last ablation vs. before first ablation (mean: 0.5 vs. 10.9 events/year, p<0.001). Use of AADs decreased after ablation (22.2% vs. 51.9%, p<0.001).\n\n\nCONCLUSIONS\nIn ARVC patients, RFA provided good VT-free survival after a single procedure, with multiple procedures required for more sustained freedom from VT recurrence. Importantly, there was marked reduction in VT burden, permitting discontinuation of AADs.