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

Abstract

Objective: To control ventricular arrhythmia in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C), ablation may be requiredboth 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 admittedwith a ventricular tachycardia (VT) storm, between September 2014 and October 2016. We divided patients into two groups: the PVC and VTgroups. 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 mappingand 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 PVCgroup. 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 meancontact 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 VTswere 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 patientsexperienced 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. (Anatol J Cardiol 2019;21: 187-95)