Endocardial and epicardial ablation of ventricular tachyarrhythmias in patients with arrhythmogenic right ventricular dysplasia

The objective of our study was to evaluate the effectiveness of endocardial and epicardial ablation of ventricular tachyarrhythmias in patients with arrhythmogenic right ventricular dysplasia (ARVD) during long-term follow-up. Over a period from February 2008 to February 2013 the data from 72 patients with ARVD and ventricular tachyarrhythmias were analyzed. The patients underwent endocardial (n = 72) and epicardial ablation (n = 21) of VT zone. The primary endpoint of the study was the absence of postoperative ventricular tachyarrhythmias during the long-term period of observation. The secondary endpoint was surgery complications and clinical data dynamics. The follow-up was 46.4 ± 9.2 months for patients with initial endocardial ablation and 39.7±3.5 months for patients who underwent epicardial ablation of ventricular tachycardia. The efficacy of initial ablation in patients with ARVD after one endocardial ablation without receiving AAD was 57% (51 patients), and after repeated endocardial ablation - 86.2% (44 of 51 patients). 21 of 31 (67.7%) patients had epicardial ablation. At the end of the follow-up paroxysmal ventricular tachycardia was observed in 15 (71.4 %) out of 21 patients. Repeated ablation of both the epicardial side and endocardial one was performed in 4 (19.1%) patients with recurrent ventricular tachycardia. Thus, the overall efficacy of the endocardial and epicardial ablation after repeated procedures was 84.7% (61 patients). Hence, a conclusion might be made that in patients with ARVD and ventricular tachyarrhythmias endocardial and epicardial ablation is an effective and safe method for treatment of ventricular tachycardia that allows eliminating most of VT of the patients in this group during long-term follow-up.