Epicardial Ablation of Ventricular Tachycardia in Arrhythmogenic Right Ventricular Cardiomyopathy

摘要

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited heart muscle disease predominantly caused by mutations in genes encoding desmosomal proteins. The hallmarks of the disease are progressive fibrofatty replacement of the myocardium, right ventricular (RV) enlargement, and malignant ventricular arrhythmias (VAs). Although the RV is typically affected, early and primary left ventricular (LV) involvement is now well recognized. VA in the form of frequent premature ventricular contractions (PVCs) and recurrent ventricular tachycardia (VT) may be seen in all stages of the disease and are associated with the risk of sudden cardiac death. In patients who fail antiarrhythmic medical therapy, catheter ablation (CA) has become an attractive option, as it reduces VT burden and the number of implantable cardioverter-defibrillator (ICD) shocks. Despite this, VT recurrence is not uncommon, and repeat ablation procedures are required in a significant number of patients. Over the past decade, remarkable technological advances, as well as a better understanding of the pattern of cardiac involvement, have expanded the role of epicardial ablation strategies, leading to improved long-term results and safer risk profiles. In this article, the authors aim to address the overall concepts of epicardial CA in ARVC, focusing on substrate characterization and ablation strategies.