Long-Term Efficacy of Catheter Ablation of Ventricular Tachycardia in Patients With Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy

Darshan Dalal, Rahul Jain, Harikrishna Tandri, Jun Dong, Shaker M Eid, Kalpana Prakasa, Crystal Tichnell, Cynthia Anne James, Theodore Abraham, Stuart D. Russell, Sunil Sinha, Daniel P. Judge, David A. Bluemke, Joseph Marine, Hugh Calkins

Research output: Contribution to journalArticle

Abstract

Objectives: This study sought to evaluate the outcomes of radiofrequency catheter ablation (RFA) of ventricular tachycardia (VT) in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) patients. Particular focus was placed on defining the single-procedure efficacy over long-term follow-up. Background: ARVD/C is an inherited cardiomyopathy characterized by VT and right ventricular dysfunction. Prior single-center studies have reported conflicting results concerning the efficacy of RFA of VT in ARVD/C patients. Methods: The study population comprised 24 patients (age 36 ± 9 years, 11 male), enrolled in the Johns Hopkins ARVD registry, who underwent 1 or more RFA procedures for treatment of VT. Patients were followed up for 32 ± 36 months (range 1 day to 12 years). Recurrence was defined as the documentation of VT subsequent to the procedure. Results: A total of 48 RFA procedures were performed using 3-dimensional electroanatomical (n = 10) or conventional (n = 38) mapping. Of these procedures, 22 (46%), 15 (31%), and 11 (23%) resulted in elimination of all inducible VTs, clinical VT but not all, and none of the inducible VTs, respectively. Forty (85%) procedures were followed by recurrence. The cumulative VT recurrence-free survival was 75%, 50%, and 25% after 1.5, 5, and 14 months, respectively. The cumulative VT recurrence-free survival did not differ by procedural success, mapping technique, or repetition of procedures. There was 1 procedure-related death. Conclusions: Our study shows a high rate of recurrence in ARVD/C patients undergoing RFA of VT. This likely reflects the fact that ARVD/C is a diffuse cardiomyopathy with progressively evolving electrical substrate. Further studies are needed to define the precise role of RFA of VT in ARVD/C.

Original languageEnglish (US)
Pages (from-to)432-440
Number of pages9
JournalJournal of the American College of Cardiology
Volume50
Issue number5
DOIs
StatePublished - Jul 31 2007

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Arrhythmogenic Right Ventricular Dysplasia
Catheter Ablation
Ventricular Tachycardia
Recurrence
Cardiomyopathies
Right Ventricular Dysfunction
Survival
Documentation
Registries

ASJC Scopus subject areas

  • Nursing(all)

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Long-Term Efficacy of Catheter Ablation of Ventricular Tachycardia in Patients With Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy. / Dalal, Darshan; Jain, Rahul; Tandri, Harikrishna; Dong, Jun; Eid, Shaker M; Prakasa, Kalpana; Tichnell, Crystal; James, Cynthia Anne; Abraham, Theodore; Russell, Stuart D.; Sinha, Sunil; Judge, Daniel P.; Bluemke, David A.; Marine, Joseph; Calkins, Hugh.

In: Journal of the American College of Cardiology, Vol. 50, No. 5, 31.07.2007, p. 432-440.

Research output: Contribution to journalArticle

Dalal, Darshan ; Jain, Rahul ; Tandri, Harikrishna ; Dong, Jun ; Eid, Shaker M ; Prakasa, Kalpana ; Tichnell, Crystal ; James, Cynthia Anne ; Abraham, Theodore ; Russell, Stuart D. ; Sinha, Sunil ; Judge, Daniel P. ; Bluemke, David A. ; Marine, Joseph ; Calkins, Hugh. / Long-Term Efficacy of Catheter Ablation of Ventricular Tachycardia in Patients With Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy. In: Journal of the American College of Cardiology. 2007 ; Vol. 50, No. 5. pp. 432-440.
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abstract = "Objectives: This study sought to evaluate the outcomes of radiofrequency catheter ablation (RFA) of ventricular tachycardia (VT) in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) patients. Particular focus was placed on defining the single-procedure efficacy over long-term follow-up. Background: ARVD/C is an inherited cardiomyopathy characterized by VT and right ventricular dysfunction. Prior single-center studies have reported conflicting results concerning the efficacy of RFA of VT in ARVD/C patients. Methods: The study population comprised 24 patients (age 36 ± 9 years, 11 male), enrolled in the Johns Hopkins ARVD registry, who underwent 1 or more RFA procedures for treatment of VT. Patients were followed up for 32 ± 36 months (range 1 day to 12 years). Recurrence was defined as the documentation of VT subsequent to the procedure. Results: A total of 48 RFA procedures were performed using 3-dimensional electroanatomical (n = 10) or conventional (n = 38) mapping. Of these procedures, 22 (46{\%}), 15 (31{\%}), and 11 (23{\%}) resulted in elimination of all inducible VTs, clinical VT but not all, and none of the inducible VTs, respectively. Forty (85{\%}) procedures were followed by recurrence. The cumulative VT recurrence-free survival was 75{\%}, 50{\%}, and 25{\%} after 1.5, 5, and 14 months, respectively. The cumulative VT recurrence-free survival did not differ by procedural success, mapping technique, or repetition of procedures. There was 1 procedure-related death. Conclusions: Our study shows a high rate of recurrence in ARVD/C patients undergoing RFA of VT. This likely reflects the fact that ARVD/C is a diffuse cardiomyopathy with progressively evolving electrical substrate. Further studies are needed to define the precise role of RFA of VT in ARVD/C.",
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T1 - Long-Term Efficacy of Catheter Ablation of Ventricular Tachycardia in Patients With Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy

AU - Dalal, Darshan

AU - Jain, Rahul

AU - Tandri, Harikrishna

AU - Dong, Jun

AU - Eid, Shaker M

AU - Prakasa, Kalpana

AU - Tichnell, Crystal

AU - James, Cynthia Anne

AU - Abraham, Theodore

AU - Russell, Stuart D.

AU - Sinha, Sunil

AU - Judge, Daniel P.

AU - Bluemke, David A.

AU - Marine, Joseph

AU - Calkins, Hugh

PY - 2007/7/31

Y1 - 2007/7/31

N2 - Objectives: This study sought to evaluate the outcomes of radiofrequency catheter ablation (RFA) of ventricular tachycardia (VT) in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) patients. Particular focus was placed on defining the single-procedure efficacy over long-term follow-up. Background: ARVD/C is an inherited cardiomyopathy characterized by VT and right ventricular dysfunction. Prior single-center studies have reported conflicting results concerning the efficacy of RFA of VT in ARVD/C patients. Methods: The study population comprised 24 patients (age 36 ± 9 years, 11 male), enrolled in the Johns Hopkins ARVD registry, who underwent 1 or more RFA procedures for treatment of VT. Patients were followed up for 32 ± 36 months (range 1 day to 12 years). Recurrence was defined as the documentation of VT subsequent to the procedure. Results: A total of 48 RFA procedures were performed using 3-dimensional electroanatomical (n = 10) or conventional (n = 38) mapping. Of these procedures, 22 (46%), 15 (31%), and 11 (23%) resulted in elimination of all inducible VTs, clinical VT but not all, and none of the inducible VTs, respectively. Forty (85%) procedures were followed by recurrence. The cumulative VT recurrence-free survival was 75%, 50%, and 25% after 1.5, 5, and 14 months, respectively. The cumulative VT recurrence-free survival did not differ by procedural success, mapping technique, or repetition of procedures. There was 1 procedure-related death. Conclusions: Our study shows a high rate of recurrence in ARVD/C patients undergoing RFA of VT. This likely reflects the fact that ARVD/C is a diffuse cardiomyopathy with progressively evolving electrical substrate. Further studies are needed to define the precise role of RFA of VT in ARVD/C.

AB - Objectives: This study sought to evaluate the outcomes of radiofrequency catheter ablation (RFA) of ventricular tachycardia (VT) in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) patients. Particular focus was placed on defining the single-procedure efficacy over long-term follow-up. Background: ARVD/C is an inherited cardiomyopathy characterized by VT and right ventricular dysfunction. Prior single-center studies have reported conflicting results concerning the efficacy of RFA of VT in ARVD/C patients. Methods: The study population comprised 24 patients (age 36 ± 9 years, 11 male), enrolled in the Johns Hopkins ARVD registry, who underwent 1 or more RFA procedures for treatment of VT. Patients were followed up for 32 ± 36 months (range 1 day to 12 years). Recurrence was defined as the documentation of VT subsequent to the procedure. Results: A total of 48 RFA procedures were performed using 3-dimensional electroanatomical (n = 10) or conventional (n = 38) mapping. Of these procedures, 22 (46%), 15 (31%), and 11 (23%) resulted in elimination of all inducible VTs, clinical VT but not all, and none of the inducible VTs, respectively. Forty (85%) procedures were followed by recurrence. The cumulative VT recurrence-free survival was 75%, 50%, and 25% after 1.5, 5, and 14 months, respectively. The cumulative VT recurrence-free survival did not differ by procedural success, mapping technique, or repetition of procedures. There was 1 procedure-related death. Conclusions: Our study shows a high rate of recurrence in ARVD/C patients undergoing RFA of VT. This likely reflects the fact that ARVD/C is a diffuse cardiomyopathy with progressively evolving electrical substrate. Further studies are needed to define the precise role of RFA of VT in ARVD/C.

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