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Characteristics of recurrent ventricular tachyarrhythmia after catheter ablation in patients with arrhythmogenic right ventricular cardiomyopathy
Author(s) -
Lin ChinYu,
Chung FaPo,
Kuo Ling,
Lin YennJiang,
Chang ShihLin,
Lo LiWei,
Hu YuFeng,
Tuan TaChuan,
Chao TzeFan,
Liao JoNan,
Chang TingYung,
Yamada Shinya,
Te Abigail Louise D.,
Huang TingChun,
Chen ShihAnn
Publication year - 2019
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.13853
Subject(s) - medicine , cardiology , catheter ablation , ablation , cardiomyopathy , refractory (planetary science) , hazard ratio , confidence interval , ventricular remodeling , ischemic cardiomyopathy , heart failure , ejection fraction , physics , astrobiology
Background The reason for recurrence of ventricular arrhythmia (VA) after catheter ablation in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) is not clear. Methods In this study, 91 ARVC patients (age, 47 ± 13 years; 47 men) who underwent catheter ablation for drug‐refractory ventricular arrhythmia (VA) were enrolled. The patients were categorized into single or multiple procedures (n = 28). The baseline characteristics and electrophysiological features of the patients were examined to elucidate the reason of the VA recurrences. Results A total of 186 VAs were induced during the index procedure and 176 (94.6%) were eliminated. Successful, partially successful, and failed ablations were achieved in 89.0%, 8.8%, and 2.2% of the patients, respectively. During a mean follow‐up period of 32 ± 26 months, 35 patients had VA recurrences. Forty‐two repeat procedures were performed for 81 induced VAs in 28 patients. Of the 42 repeat procedures, successful, partially successful, and failed ablations were achieved in 37, 4, and 1 of the procedures, respectively. Most of the recurrent VAs (70 [72.9%]) originated from the newly‐developed circuits owing to the scar progression. The patients with repeat procedure had worsening right ventricular remodeling. The multivariate analysis revealed that history as endurance athlete significantly predicted the need of a repeat procedure in spite of the initially successful endocardial/epicardial ablation and negative inducibility (hazard ratio: 3.014, 95% confidence interval: 1.493‐6.084, P = 0.002). Conclusions In spite of the initial complete VA elimination, history as an athlete was associated with scar progression, RV remodeling, and VA recurrences from the newly developed arrhythmogenic substrates/circuit in ARVC.