Interv Akut Kardiol. 2003;2(3):129-132

Radiofrequency catheter ablation of ventricular tachycardia in arrhythmogenic right ventricular dysplasia

Josef Kautzner, Robert Čihák, Vlastimil Vančura, Kateřina Lefflerová, Jan Bytešník

Klinika kardiologie, Institut klinické a experimentální medicíny, Praha

Background: Ventricular tachycardia (VT) in arrhythmogenic right ventricular dysplasia (ARVD) is believed to be of intramyocardial reentry origin. However, there is still limited information about the character of reentry circuits, and about the long-term benefit of radiofrequency (RF) catheter ablation.

Methods: To address this issue, 8 monomorphic, hemodynamically stable VTs were mapped in 6 patients with ARVD (5 men, mean age 48±15 years). After identification of late potentials in sinus rhythm, VT was induced by programmed ventricular stimulation. Entrainment was performed during mapping by pacing from the distal bipole of the mapping catheter at cycle length 20-50 ms shorter than that of VT. RF current was applied in areas judged to be central or exit, or (in the case when pacing was impossible) in areas with mid-diastolic potentials close to the entrainable site. The success of RF ablation was defined as termination of VT and non-inducibility of clinical (or hemodynamically stable) VT.

Results: RF ablation was successful in 5 patients, and in 7 of 8 clinical VTs. The mean procedure duration was 188 ± 112 min with the mean fluoroscopic time of 12.8 ± 10 min. During mid-term follow-up (33 ± 7 months, range 22-39), 2 recurrences of VT of different morphology were noticed within 1 year period, and RF ablation was successfully repeated in both cases. Long-term follow-up (mean 48 ± 16 months, range 26–63) revealed that three patients died: none of them suddenly, two of them defintely not of arrhythmia recurrence. One re-ablation supported by electroanatomical mapping was performed in the patient with initially unsuccessful RF ablation. Two other patients are without recurrences of arrhythmias.

Conclusions: VT in ARVD shows many characteristics of VT after myocardial infarction. RF catheter ablation of VT in ARVD guided by activation sequence and entrainment mapping appears to be effective and safe technique for selected patients.

Keywords: ventricular tachycardia, arrhythmogenic right ventricular dysplasia, radiofrequency catheter ablation, entrainment mapping.

Published: December 31, 2003  Show citation