Arrhythmogenic right ventricular cardiomyopathy: challenges of interventional treatment of ventricular tachyarrhythmias

The objective of the study was to estimate capabilities of the interventional treatment of arrhythmogenic right ventricular cardiomyopathy (ARVD). The study included 25 individuals: 16 patients with high grade ventricular extrasystoles (VE) (subgroup 1) and 9 patients with episodes of stable VE and/or ventricular fibrillation (VF) in past medical history (subgroup 2). Endomyocardial biopsy was performed to confirm diagnosis in all patients. The treatment modality (drug therapy, radiofrequency ablation (RFA), and cardioverterdefibrillator implantation (CDI)) was selected individually for each patient. The RFA treatment was considered a priority in cases of monomorphic ectopia or in the presence of several definite ectopia foci with predominant morphology. All patients of subgroup 2 received CDI. Actuations of the implantable cardioverter defibrillator, caused by stable and rapid VE/VF, occurred in 7 of 9 patients. All patients received drug therapy. Endomyocardial biopsy provided diagnostic information used to rule out the reversible cause of ventricular tachyarrhythmia (VTA), active myocarditis. Establishment of ARVD diagnosis was extremely important for prognosis and selection of proper treatment of patients with VTA. Early and longterm efficacy rates of RFA in VE and unstable ventricular tachycardia were 88 and 56%, respectively. The best candidates for RFA were patients with monomorphic ectopia. Patients with polymorphic VE have high risk of new onset or increase in ectopic VE of new morphology after RFA.