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Safety, long-term outcomes and predictors of recurrence after first-line combined endoepicardial ventricular tachycardia substrate ablation in arrhythmogenic cardiomyopathy. Impact of arrhythmic substrate distribution pattern. A prospective multicentre study.

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2017

Authors

Berruezo, Antonio
Acosta, Juan
Fernández-Armenta, Juan
Pedrote, Alonso
Barrera, Alberto
Arana-Rueda, Eduardo
Bodegas, Andrés Ignacio
Anguera, Ignasi
Tercedor, Luis
Penela, Diego

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Abstract

First-line endoepicardial ventricular tachycardia (VT) ablation has been proposed for patients with arrhythmogenic cardiomyopathy (AC). This study reports procedural safety, outcomes, and predictors of recurrence. Forty-one consecutive patients [12 with left ventricle (LV) involvement, 7 left-dominant] underwent first-line endoepicardial VT substrate ablation. Standard bipolar and unipolar thresholds were used to define low-voltage areas (LVA). Arrhythmogenic substrate area (ASA) was defined as the area containing electrograms with delayed components. Implantable cardioverter defibrillator interrogations were evaluated for VT recurrence. Epicardial LVA was larger in all cases (102.5 ± 78.6 vs. 19.3 ± 24.4 cm2; P0.23 predicted an epi-ASA ≤10 cm2 (100% sensitivity, 84% specificity). Patients showing an epi-ASA First-line endoepicardial VT substrate ablation achieves good long-term results in AC. Left-dominant AC is associated with an increased risk of recurrence. The Bi/Uni-LVA ratio identifies patients with limited epicardial arrhythmogenic substrate in whom the indication of epicardial approach should be more cautiously assessed.

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MeSH Terms

Adult
Arrhythmogenic Right Ventricular Dysplasia
Catheter Ablation
Causality
Combined Modality Therapy
Comorbidity
Endocardium
Female
Humans
Longitudinal Studies
Male
Middle Aged
Pericardium
Prevalence
Recurrence
Risk Factors
Secondary Prevention
Spain
Survival Rate
Tachycardia, Ventricular
Treatment Outcome

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Keywords

Arrhythmogenic cardiomyopathy, Epicardial ablation, Long-term outcomes, Scar dechanneling, Ventricular tachycardia

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