Berruezo, AntonioAcosta, JuanFernández-Armenta, JuanPedrote, AlonsoBarrera, AlbertoArana-Rueda, EduardoBodegas, Andrés IgnacioAnguera, IgnasiTercedor, LuisPenela, DiegoAndreu, DavidPerea, Rosario JesusPrat-González, SusanaMont, Lluis2023-01-252023-01-252017http://hdl.handle.net/10668/11124First-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.enArrhythmogenic cardiomyopathyEpicardial ablationLong-term outcomesScar dechannelingVentricular tachycardiaAdultArrhythmogenic Right Ventricular DysplasiaCatheter AblationCausalityCombined Modality TherapyComorbidityEndocardiumFemaleHumansLongitudinal StudiesMaleMiddle AgedPericardiumPrevalenceRecurrenceRisk FactorsSecondary PreventionSpainSurvival RateTachycardia, VentricularTreatment Outcomeresearch article28431051open access10.1093/europace/euw2121532-2092https://academic.oup.com/europace/article-pdf/19/4/607/13692177/euw212.pdf