Endo/epicardial ablation of ventricular arrhythmias with contact force-sensing catheters in arrhythmogenic right ventricular dysplasia/cardiomyopathy.

OBJECTIVE

To control ventricular arrhythmia in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C), ablation may be required both from the endocardial and epicardial side. In this study, we analyzed the results of contact force-sensing (CFS) catheters in the endo/epicardial ablation of ventricular arrhythmias in ARVD/C.

METHODS

We included 17 patients with ARVD/C, 5 of whom had premature ventricular contractions (PVC), and the rest of them were admitted with a ventricular tachycardia (VT) storm, between September 2014 and October 2016. We divided patients into two groups: the PVC and VT groups. Irrigated CFS catheters (Smart Touch, Biosense Webster, Inc.) were utilized in all procedures.

RESULTS

In the PVC group, the mean ratio of PVC during the 24-hour Holter monitoring was 31.8+-7.6%. The mean contact force during mapping and ablation in the right ventricle was 13+-1.2 and 12.8+-1.9 grams, respectively. The mean follow-up duration was 15+-3.1 months for the PVC group. The left ventricular ejection fraction improved in all patients (52.8+-10%). All patients in the VT group underwent endo/epicardial ablation, except one. The mean contact force during the endocardium and epicardium mapping was 12.5+-1.2 and 12.5+-4.6 grams, respectively. The mean contact force during ablation for the endocardium and epicardium was 12.1+-1.4 and 12.8+-1.9 grams, respectively. All clinical and non-clinical VTs were ablated successfully, except in 2 patients who still had non-clinical VTs. The mean follow-up was 15.5+-4.5 months. None of the VT patients experienced electrical storm or death. Two patients had single shock, and 1 patient had two shocks during the follow-up.

CONCLUSION

Endo/epicardial ablation of ventricular arrhythmias with CFS catheters in ARVD/C seems to be promising.